| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $70 | $70 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $271 | $271 | $271 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $277 | $277 | $277 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $80 | $80 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $80 | $80 |
| EMG needle each extremity complete CPT 95886 • Neurology | $129 | $129 | $129 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $164 | $164 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $197 | $197 | $197 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $259 | $259 | $259 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $412 | $412 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $51 | $76 | $102 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $73 | $145 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $112 | $284 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $93 | $193 | $282 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $33 | $41 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $33 | $36 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $65 | $99 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $95 | $147 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $103 | $163 | $198 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $46 | $93 | $139 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $72 | $130 | $189 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $143 | $187 | $232 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $31 | $42 | $53 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $60 | $80 | $99 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $32 | $105 | $179 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $10 | $55 | $100 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $125 | $136 | $147 |
| Consultation office straightforward CPT 99241 • Office Visits | $25 | $25 | $25 |
| Consultation office low complexity CPT 99243 • Office Visits | $78 | $123 | $168 |
| Consultation office high complexity CPT 99245 • Office Visits | $138 | $238 | $338 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $729 | $729 | $729 |
| Visual field examination CPT 92083 • Ophthalmology | $85 | $85 | $85 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $84 | $84 | $84 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $67 | $67 | $67 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $89 | $89 | $89 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $62 | $62 | $62 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $316 | $316 | $316 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,533 | $2,533 | $2,533 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $449 | $449 | $449 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $387 | $387 | $387 |
| Total hip replacement CPT 27130 • Orthopedics | $2,383 | $2,383 | $2,383 |
| Total knee replacement CPT 27447 • Orthopedics | $1,864 | $1,864 | $1,864 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $426 | $426 | $426 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $308 | $308 | $308 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,444 | $1,444 | $1,444 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $755 | $755 | $755 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $927 | $927 | $927 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,324 | $1,324 | $1,324 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,324 | $1,324 | $1,324 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $204 | $204 |