| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $270 | $270 | $270 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $91 | $91 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $129 | $129 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $166 | $181 | $196 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $246 | $246 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $20 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $54 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $110 | $110 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $160 | $160 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $173 | $173 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $61 | $61 | $61 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $97 | $97 | $97 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $152 | $153 | $153 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $59 | $59 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $105 | $105 | $105 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $53 | $53 | $53 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $101 | $101 | $101 |
| Consultation office low complexity CPT 99243 • Office Visits | $71 | $89 | $108 |
| Consultation office high complexity CPT 99245 • Office Visits | $200 | $201 | $201 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $580 | $580 | $580 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,013 | $1,013 | $1,013 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $468 | $470 | $472 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $278 | $278 | $278 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $478 | $478 | $478 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $315 | $315 | $316 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $422 | $422 | $422 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $733 | $733 | $733 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $137 | $137 | $137 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $80 | $80 | $80 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $47 | $47 | $47 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $38 | $38 | $38 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $15 | $15 | $15 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $59 | $59 | $59 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,478 | $1,478 | $1,478 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,395 | $1,395 | $1,395 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,585 | $1,585 | $1,585 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $270 | $270 | $270 |
| Total hip replacement CPT 27130 • Orthopedics | $1,159 | $1,159 | $1,159 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,506 | $1,506 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,080 | $1,080 | $1,080 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,038 | $1,038 | $1,038 |
| Total knee replacement CPT 27447 • Orthopedics | $1,158 | $1,159 | $1,161 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $530 | $537 | $544 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $810 | $817 | $823 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $971 | $971 | $971 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $514 | $514 | $514 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $496 | $498 | $499 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $804 | $804 | $804 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $971 | $971 | $971 |