| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $351 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $407 | $407 | $407 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $150 | $150 | $150 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $164 | $164 | $164 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $268 | $268 | $268 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $51 | $51 | $51 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $79 | $79 | $79 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $119 | $119 | $119 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $158 | $158 | $158 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $6 | $6 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $40 | $40 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $64 | $64 | $64 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $92 | $92 | $92 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $128 | $128 | $128 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $59 | $59 | $59 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $93 | $93 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $125 | $125 | $125 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $35 | $35 | $35 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $57 | $57 | $57 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $86 | $86 | $86 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $58 | $58 | $58 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $82 | $82 | $83 |
| Consultation office low complexity CPT 99243 • Office Visits | $101 | $101 | $101 |
| Consultation office high complexity CPT 99245 • Office Visits | $189 | $189 | $190 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $460 | $460 | $460 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $36 | $36 | $36 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,100 | $1,100 | $1,100 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,019 | $1,019 | $1,019 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $470 | $470 | $471 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $481 | $481 | $481 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $317 | $317 | $317 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $424 | $424 | $424 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $550 | $648 | $746 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $137 | $137 | $137 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $71 | $71 | $71 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $79 | $79 | $79 |
| Visual field examination CPT 92083 • Ophthalmology | $51 | $51 | $51 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $12 | $12 | $12 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $39 | $39 | $39 |
| Fundus photography CPT 92250 • Ophthalmology | $17 | $17 | $17 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $60 | $60 | $60 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,533 | $1,533 | $1,533 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,440 | $1,440 | $1,440 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,634 | $1,634 | $1,635 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,336 | $1,336 | $1,336 |
| Total hip replacement CPT 27130 • Orthopedics | $1,186 | $1,186 | $1,186 |