| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $171 | $171 | $171 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $278 | $278 | $278 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $71 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $30 | $30 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $30 | $30 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $104 | $115 | $126 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $30 | $30 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $30 | $30 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $48 | $56 | $65 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $30 | $30 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $79 | $79 | $79 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $51 | $51 | $51 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $46 | $46 | $46 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $67 | $67 | $67 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $77 | $77 | $77 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $144 | $144 | $144 |
| Consultation office low complexity CPT 99243 • Office Visits | $0 | $65 | $129 |
| Consultation office high complexity CPT 99245 • Office Visits | $0 | $134 | $268 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,387 | $1,387 | $1,387 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $648 | $648 | $648 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $452 | $452 | $452 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $87 | $144 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,491 | $1,491 | $1,491 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $657 | $657 | $657 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $517 | $517 | $517 |
| Excision chalazion single CPT 67800 • Ophthalmology | $167 | $167 | $167 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $51 | $51 | $51 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $40 | $40 | $40 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $50 | $50 | $50 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $51 | $51 | $51 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $60 | $60 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $47 | $47 | $47 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $58 | $58 | $58 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $51 | $51 | $51 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,884 | $1,884 | $1,884 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,662 | $1,662 | $1,662 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $442 | $442 | $442 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $649 | $649 | $649 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,239 | $1,239 | $1,239 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,274 | $1,274 | $1,274 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,190 | $1,190 | $1,190 |
| Total knee replacement CPT 27447 • Orthopedics | $1,328 | $1,328 | $1,328 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $746 | $746 | $746 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $343 | $343 | $343 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $937 | $937 | $937 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $175 | $175 | $175 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,113 | $1,113 | $1,113 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $51 | $51 | $51 |