| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $1,137 | $3,508 | $4,694 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $678 | $3,690 | $4,694 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $678 | $3,690 | $4,694 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $295 | $295 | $295 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $366 | $366 | $366 |
| EMG needle each extremity complete CPT 95886 • Neurology | $117 | $117 | $117 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $102 | $102 | $102 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $122 | $122 | $122 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $65 | $65 | $65 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $143 | $143 | $143 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $167 | $167 | $167 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $223 | $223 | $223 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $18 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $47 | $47 | $47 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $89 | $89 | $89 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $178 | $178 | $178 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $181 | $181 | $181 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $76 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $169 | $169 | $169 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $161 | $161 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $68 | $68 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $109 | $109 | $109 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $105 | $105 | $105 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $106 | $106 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,500 | $3,629 | $4,694 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $678 | $3,355 | $4,694 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $4,754 | $5,631 | $6,612 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $220 | $2,096 | $4,694 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,807 | $4,222 | $4,694 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $2,807 | $4,222 | $4,694 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $1,137 | $2,521 | $4,694 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $417 | $2,915 | $4,694 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $455 | $3,469 | $4,694 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $160 | $2,391 | $4,694 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $4,694 | $5,148 | $6,391 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,137 | $3,805 | $4,694 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $305 | $3,105 | $4,694 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $2,807 | $4,065 | $4,694 |
| Excision chalazion single CPT 67800 • Ophthalmology | $678 | $3,690 | $4,694 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $2,807 | $4,222 | $4,694 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $119 | $1,806 | $4,694 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $124 | $124 | $124 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $74 | $74 | $74 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $105 | $105 | $105 |
| Visual field examination CPT 92083 • Ophthalmology | $52 | $52 | $52 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $23 | $23 | $23 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $40 | $40 | $40 |
| Fundus photography CPT 92250 • Ophthalmology | $31 | $31 | $31 |