| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $133 | $133 | $133 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $50 | $50 | $50 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $77 | $77 | $77 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $144 | $144 | $144 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $152 | $152 | $152 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $10 | $10 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $26 | $26 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $55 | $55 | $55 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $87 | $87 | $87 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $127 | $127 | $127 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $73 | $73 | $73 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $120 | $120 | $120 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $168 | $168 | $168 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $36 | $36 | $36 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $60 | $60 | $60 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $85 | $85 | $85 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $76 | $76 | $76 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $103 | $103 |
| Consultation office low complexity CPT 99243 • Office Visits | $129 | $129 | $129 |
| Consultation office high complexity CPT 99245 • Office Visits | $196 | $196 | $196 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $605 | $605 | $605 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $55 | $55 | $55 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,203 | $1,203 | $1,203 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $361 | $361 | $361 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,083 | $1,083 | $1,083 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $581 | $581 | $581 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $426 | $426 | $426 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,046 | $1,046 | $1,046 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $789 | $789 | $789 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $180 | $180 | $180 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,582 | $1,582 | $1,582 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $661 | $661 | $661 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,080 | $1,080 | $1,080 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $566 | $566 | $566 |
| Excision chalazion single CPT 67800 • Ophthalmology | $133 | $133 | $133 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $559 | $559 | $559 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $159 | $159 | $159 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $75 | $75 | $75 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $97 | $97 | $97 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $68 | $68 | $68 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $101 | $101 | $101 |
| Visual field examination CPT 92083 • Ophthalmology | $30 | $30 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $34 | $34 | $34 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $88 | $88 | $88 |
| Fundus photography CPT 92250 • Ophthalmology | $26 | $26 | $26 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $47 | $47 | $47 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $48 | $48 | $48 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $57 | $57 | $57 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,138 | $2,138 | $2,138 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,678 | $1,678 | $1,678 |