| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $234 | $234 | $234 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $84 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $111 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $99 | $135 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $218 | $230 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $30 | $45 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $56 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $56 | $89 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $110 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $162 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $45 | $56 | $65 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $45 | $80 | $103 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $45 | $145 | $214 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $44 | $45 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $45 | $67 | $91 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $45 | $89 | $117 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $61 | $75 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $111 | $143 |
| Consultation office low complexity CPT 99243 • Office Visits | $108 | $108 | $108 |
| Consultation office high complexity CPT 99245 • Office Visits | $45 | $93 | $190 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $45 | $402 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $45 | $45 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $368 | $368 | $368 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $45 | $45 | $45 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $374 | $374 | $374 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $296 | $296 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $747 | $747 | $747 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $508 | $508 | $508 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $69 | $94 | $119 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $45 | $45 | $45 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $45 | $293 | $541 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $25 | $142 | $357 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $45 | $45 | $45 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $45 | $45 | $45 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $66 | $106 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $88 | $88 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $124 | $124 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $18 | $40 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $10 | $18 | $26 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $29 | $29 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $36 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $45 | $45 | $45 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $45 | $49 | $52 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,583 | $1,765 | $1,946 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $45 | $45 | $45 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,710 | $1,710 | $1,710 |
| Total hip replacement CPT 27130 • Orthopedics | $45 | $45 | $45 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $45 | $45 | $45 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $45 | $45 | $45 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $45 | $45 | $45 |