| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $281 | $281 | $281 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $59 | $59 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $88 | $88 | $88 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $139 | $139 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $176 | $176 | $176 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $18 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $44 | $44 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $72 | $72 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $102 | $102 | $102 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $143 | $143 | $143 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $135 | $135 | $135 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $135 | $135 | $135 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $190 | $190 | $190 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $81 | $81 | $81 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $129 | $129 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $98 | $98 | $98 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $81 | $81 | $81 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $129 | $129 | $129 |
| Consultation office low complexity CPT 99243 • Office Visits | $134 | $134 | $134 |
| Consultation office high complexity CPT 99245 • Office Visits | $195 | $195 | $195 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $531 | $531 | $531 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $44 | $44 | $44 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,319 | $1,319 | $1,319 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $279 | $279 | $279 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,228 | $1,228 | $1,228 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $569 | $569 | $569 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $341 | $341 | $341 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $837 | $837 | $837 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $611 | $611 | $611 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $128 | $128 | $128 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,335 | $1,335 | $1,335 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $582 | $582 | $582 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $384 | $384 | $384 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $671 | $671 | $671 |
| Excision chalazion single CPT 67800 • Ophthalmology | $145 | $145 | $145 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $912 | $912 | $912 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $170 | $170 | $170 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $79 | $79 | $79 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $138 | $138 | $138 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $82 | $82 | $82 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $116 | $116 | $116 |
| Visual field examination CPT 92083 • Ophthalmology | $58 | $58 | $58 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $37 | $37 | $37 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $50 | $50 | $50 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $36 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $53 | $53 | $53 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $55 | $55 | $55 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $65 | $65 | $65 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,743 | $1,743 | $1,743 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,627 | $1,627 | $1,627 |