| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $176 | $176 | $176 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $288 | $288 | $288 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $75 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $118 | $142 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $168 | $187 | $205 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $247 | $257 | $266 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $25 | $27 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $47 | $57 | $66 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $63 | $79 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $70 | $110 | $150 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $211 | $222 | $234 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $83 | $121 | $159 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $159 | $164 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $220 | $223 | $225 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $64 | $69 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $75 | $89 | $103 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $113 | $133 | $153 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $76 | $77 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $117 | $132 | $147 |
| Consultation office low complexity CPT 99243 • Office Visits | $41 | $41 | $41 |
| Consultation office high complexity CPT 99245 • Office Visits | $41 | $41 | $41 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $41 | $400 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $41 | $41 | $41 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $992 | $992 | $992 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $41 | $143 | $245 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $41 | $41 | $41 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $41 | $169 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $41 | $352 | $663 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $41 | $198 | $355 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $41 | $76 | $111 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $41 | $616 | $1,192 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $41 | $278 | $515 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $41 | $199 | $357 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $520 | $520 | $520 |
| Excision chalazion single CPT 67800 • Ophthalmology | $41 | $81 | $121 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $41 | $41 | $41 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $104 | $153 | $201 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $74 | $74 | $74 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $137 | $142 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $79 | $83 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $114 | $117 | $121 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $56 | $86 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $32 | $38 | $44 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $35 | $41 |
| Fundus photography CPT 92250 • Ophthalmology | $29 | $52 | $75 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $38 | $50 | $62 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $36 | $39 | $41 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $76 | $102 | $129 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $913 | $1,562 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,440 | $1,440 | $1,440 |