| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $139 | $139 | $139 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $72 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $80 | $80 | $80 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $151 | $151 | $151 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $159 | $159 | $159 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $27 | $27 | $27 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $40 | $40 | $40 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $91 | $91 | $91 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $106 | $106 | $106 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $76 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $126 | $126 | $126 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $175 | $175 | $175 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $38 | $38 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $62 | $62 | $62 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $88 | $88 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $79 | $79 | $79 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $108 | $108 | $108 |
| Consultation office low complexity CPT 99243 • Office Visits | $5 | $5 | $5 |
| Consultation office high complexity CPT 99245 • Office Visits | $5 | $5 | $5 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $693 | $693 | $693 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $58 | $58 | $58 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,253 | $1,253 | $1,253 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $377 | $377 | $377 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,128 | $1,128 | $1,128 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $605 | $605 | $605 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $387 | $387 | $387 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,089 | $1,089 | $1,089 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $822 | $822 | $822 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $241 | $241 | $241 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,648 | $1,648 | $1,648 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $688 | $688 | $688 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,125 | $1,125 | $1,125 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $590 | $590 | $590 |
| Excision chalazion single CPT 67800 • Ophthalmology | $138 | $138 | $138 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $582 | $582 | $582 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $166 | $166 | $166 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $53 | $53 | $53 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $101 | $101 | $101 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $41 | $41 | $41 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $106 | $106 | $106 |
| Visual field examination CPT 92083 • Ophthalmology | $31 | $31 | $31 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $36 | $36 | $36 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $33 | $33 | $33 |
| Fundus photography CPT 92250 • Ophthalmology | $27 | $27 | $27 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $62 | $62 | $62 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $68 | $68 | $68 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $59 | $59 | $59 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,228 | $2,228 | $2,228 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,748 | $1,748 | $1,748 |