| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $150 | $150 | $150 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $177 | $177 | $177 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $318 | $318 | $318 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $86 | $86 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $92 | $92 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $174 | $174 | $174 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $273 | $273 | $273 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $54 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $102 | $102 | $102 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $138 | $138 | $138 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $185 | $185 | $185 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $76 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $148 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $128 | $128 | $128 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $72 | $72 | $72 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $92 | $92 | $92 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $75 | $75 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $103 | $103 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $758 | $758 | $758 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $245 | $245 | $245 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $296 | $296 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $663 | $663 | $663 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $355 | $355 | $355 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $171 | $171 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,192 | $1,192 | $1,192 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $515 | $515 | $515 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $357 | $357 | $357 |
| Excision chalazion single CPT 67800 • Ophthalmology | $121 | $121 | $121 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $63 | $63 | $63 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $147 | $147 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $88 | $88 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $124 | $124 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $62 | $62 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $26 | $26 | $26 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $29 | $29 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $36 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $47 | $47 | $47 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $77 | $77 | $77 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $61 | $61 | $61 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $265 | $265 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,790 | $1,790 | $1,790 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $314 | $314 | $314 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,311 | $1,311 | $1,311 |
| Total knee replacement CPT 27447 • Orthopedics | $1,590 | $1,590 | $1,590 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $459 | $459 | $459 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $161 | $161 | $161 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,067 | $1,067 | $1,067 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $602 | $602 | $602 |