| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $172 | $172 | $172 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $127 | $127 | $127 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $122 | $122 | $122 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $95 | $95 | $95 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $92 | $92 | $92 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $28 | $28 | $28 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $55 | $55 | $55 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $203 | $203 | $203 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $126 | $126 | $126 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $65 | $65 | $65 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $36 | $55 | $73 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $36 | $114 | $167 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $36 | $142 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $28 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $36 | $47 | $66 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $36 | $56 | $79 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $36 | $89 | $150 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $36 | $78 | $121 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $69 | $69 | $69 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $115 | $115 | $115 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $160 | $160 | $160 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $35 | $35 | $35 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $57 | $57 | $57 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $81 | $81 | $81 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $72 | $72 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $98 | $98 | $98 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $123 | $123 | $123 |
| Consultation office high complexity CPT 99245 • Office Visits | $225 | $225 | $225 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $581 | $581 | $581 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $48 | $48 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,051 | $1,051 | $1,051 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $316 | $316 | $316 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $947 | $947 | $947 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $508 | $508 | $508 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $372 | $372 | $372 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $915 | $915 | $915 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $689 | $689 | $689 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $203 | $203 | $203 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,383 | $1,383 | $1,383 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $603 | $603 | $603 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $944 | $944 | $944 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $495 | $495 | $495 |
| Excision chalazion single CPT 67800 • Ophthalmology | $116 | $116 | $116 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $506 | $506 | $506 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $139 | $139 | $139 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $34 | $34 | $34 |