| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $105 | $140 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $69 | $82 | $107 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $107 | $118 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $123 | $155 | $206 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $162 | $196 | $248 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $21 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $52 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $71 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $113 | $132 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $159 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $93 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $124 | $127 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $140 | $177 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $79 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $72 | $110 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $10 | $68 | $99 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $72 | $110 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $102 | $110 |
| Consultation office low complexity CPT 99243 • Office Visits | $92 | $92 | $93 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $149 | $254 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $30 | $30 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $5 | $18 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $48 | $265 | $482 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $30 | $30 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $30 | $30 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $52 | $52 | $52 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $300 | $571 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $88 | $146 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $12 | $12 | $12 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $386 | $386 | $386 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $112 | $112 | $112 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $83 | $83 | $83 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $122 | $122 | $122 |
| 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 | $36 | $36 | $36 |
| 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 |
| Total shoulder replacement CPT 23472 • Orthopedics | $30 | $30 | $30 |