| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $80 | $109 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $105 | $154 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $201 | $297 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $67 | $308 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $93 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $97 | $145 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $100 | $106 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $50 | $80 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $119 | $141 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $73 | $105 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $94 | $155 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $229 | $271 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $71 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $108 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $151 | $159 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $159 | $192 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $21 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $53 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $66 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $86 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $106 | $135 | $149 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $111 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $126 | $155 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $175 | $192 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $99 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $88 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $94 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $92 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $108 | $124 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $83 | $170 |
| Consultation office high complexity CPT 99245 • Office Visits | $5 | $192 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $601 | $632 | $693 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $50 | $77 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,171 | $1,253 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $197 | $253 | $324 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $813 | $1,128 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $513 | $605 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $288 | $338 | $387 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $902 | $1,089 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $458 | $822 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $117 | $241 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $990 | $1,648 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $427 | $688 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $419 | $996 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $505 | $590 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $91 | $123 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $582 | $708 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $112 | $126 | $142 |