| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $84 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $113 | $121 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $133 | $155 | $167 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $168 | $222 | $250 |
| Office visit established patient minimal CPT 99211 • Office Visits | $26 | $28 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $48 | $52 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $72 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $107 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $173 | $174 | $175 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $88 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $98 | $114 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $148 | $181 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $88 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $75 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $87 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $76 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $129 | $130 | $131 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $72 | $114 |
| Consultation office high complexity CPT 99245 • Office Visits | $212 | $240 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $30 | $30 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $30 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $237 | $237 | $237 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $483 | $483 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $276 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $30 | $30 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $30 | $30 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $30 | $30 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $772 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $112 | $112 | $112 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $74 | $98 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $34 | $34 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $24 | $32 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $39 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $30 | $33 | $35 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $30 | $30 | $30 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $63 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $30 | $30 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $30 | $30 |