| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $93 | $93 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $158 | $158 | $158 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $158 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $380 | $380 | $380 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $113 | $113 | $113 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $162 | $162 | $162 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $113 | $113 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $136 | $136 | $136 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $178 | $178 | $178 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $291 | $291 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $60 | $60 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $138 | $138 | $138 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $183 | $183 | $183 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $19 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $47 | $47 | $47 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $75 | $75 | $75 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $106 | $106 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $69 | $69 | $69 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $146 | $146 | $146 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $66 | $66 | $66 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $100 | $100 | $100 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $68 | $68 | $68 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $96 | $96 | $96 |
| Consultation office low complexity CPT 99243 • Office Visits | $123 | $123 | $123 |
| Consultation office high complexity CPT 99245 • Office Visits | $230 | $230 | $230 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,357 | $1,357 | $1,357 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $626 | $626 | $626 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $676 | $676 | $676 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $141 | $141 | $141 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,478 | $1,478 | $1,478 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $641 | $641 | $641 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $423 | $423 | $423 |
| Excision chalazion single CPT 67800 • Ophthalmology | $161 | $161 | $161 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $991 | $991 | $991 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $91 | $91 | $91 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $128 | $128 | $128 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $41 | $41 | $41 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $48 | $48 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $38 | $38 | $38 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $63 | $63 | $63 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $73 | $73 | $73 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,053 | $2,053 | $2,053 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,839 | $1,839 | $1,839 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $483 | $483 | $483 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $670 | $670 | $670 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,362 | $1,362 | $1,362 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,402 | $1,402 | $1,402 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,311 | $1,311 | $1,311 |
| Total knee replacement CPT 27447 • Orthopedics | $1,465 | $1,465 | $1,465 |