| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $383 | $383 | $383 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $451 | $451 | $451 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $120 | $128 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $159 | $159 |
| EMG needle each extremity complete CPT 95886 • Neurology | $100 | $100 | $100 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $101 | $101 | $101 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $109 | $120 | $131 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $206 | $206 | $206 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $321 | $321 | $321 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $75 | $75 | $75 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $106 | $106 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $96 | $130 | $165 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $212 | $212 | $212 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $22 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $44 | $44 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $73 | $73 | $73 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $108 | $108 | $108 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $143 | $143 | $143 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $100 | $100 | $100 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $135 | $135 | $135 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $164 | $181 | $199 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $38 | $38 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $71 | $71 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $102 | $102 | $102 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $72 | $72 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $105 | $107 | $109 |
| Consultation office low complexity CPT 99243 • Office Visits | $109 | $119 | $129 |
| Consultation office high complexity CPT 99245 • Office Visits | $209 | $223 | $238 |
| 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 | $1,482 | $1,482 | $1,482 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $554 | $601 | $648 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $231 | $432 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $30 | $30 | $30 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,039 | $1,039 | $1,039 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $190 | $190 | $190 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $71 | $71 | $71 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $68 | $68 | $68 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $50 | $50 | $50 |
| Visual field examination CPT 92083 • Ophthalmology | $24 | $24 | $24 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $51 | $51 | $51 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $30 | $30 |
| Fundus photography CPT 92250 • Ophthalmology | $30 | $30 | $30 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $68 | $68 | $68 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,930 | $1,930 | $1,930 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $30 | $30 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,884 | $1,884 | $1,884 |