| EMG needle each extremity complete CPT 95886 • Neurology | $99 | $99 | $99 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $93 | $93 | $93 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $117 | $117 | $117 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $108 | $108 | $108 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $298 | $298 | $298 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $63 | $66 | $69 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $102 | $102 | $102 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $77 | $124 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $33 | $36 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $28 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $28 | $38 | $47 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $60 | $69 | $78 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $36 | $52 | $69 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $156 | $156 | $156 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $79 | $107 | $135 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $153 | $153 | $153 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $36 | $131 | $225 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $81 | $81 | $81 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $81 | $100 | $120 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $115 | $117 | $120 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $81 | $100 | $120 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $117 | $117 | $118 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $72 | $114 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $124 | $217 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $590 | $590 | $590 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $49 | $49 | $49 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,356 | $1,356 | $1,356 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $623 | $623 | $624 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $928 | $928 | $928 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $641 | $641 | $641 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $227 | $424 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $742 | $742 | $742 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $30 | $30 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $83 | $83 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $96 | $96 | $96 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $14 | $14 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $53 | $53 | $53 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $30 | $30 | $30 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $78 | $78 | $78 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $36 | $53 | $69 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,883 | $1,883 | $1,883 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,755 | $1,755 | $1,755 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,050 | $2,050 | $2,050 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $458 | $458 | $458 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $884 | $884 | $884 |
| Total hip replacement CPT 27130 • Orthopedics | $1,422 | $1,422 | $1,422 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,849 | $1,849 | $1,849 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,317 | $1,317 | $1,317 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,356 | $1,356 | $1,356 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,276 | $1,402 | $1,528 |