| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $108 | $145 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $15 | $98 | $181 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $277 | $277 | $277 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $263 | $447 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $302 | $524 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $134 | $134 | $135 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $195 | $195 | $195 |
| EMG needle each extremity complete CPT 95886 • Neurology | $118 | $125 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $108 | $108 | $108 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $135 | $145 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $93 | $103 | $112 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $212 | $236 | $259 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $344 | $378 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $79 | $83 | $87 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $114 | $130 | $145 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $138 | $170 | $222 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $183 | $271 | $360 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $27 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $41 | $48 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $70 | $74 | $77 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $12 | $57 | $147 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $154 | $176 | $198 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $137 | $139 | $141 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $146 | $167 | $189 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $162 | $217 | $273 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $82 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $97 | $104 | $110 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $111 | $127 | $143 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $110 | $119 | $127 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $86 | $114 | $144 |
| Consultation office low complexity CPT 99243 • Office Visits | $10 | $119 | $210 |
| Consultation office high complexity CPT 99245 • Office Visits | $29 | $191 | $308 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $53 | $53 | $53 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $277 | $277 | $277 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $681 | $681 | $681 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $729 | $729 | $729 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $153 | $153 | $153 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $460 | $460 | $460 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,090 | $1,090 | $1,090 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $106 | $106 | $106 |
| Visual field examination CPT 92083 • Ophthalmology | $33 | $59 | $85 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $19 | $19 | $19 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $61 | $72 | $84 |
| Fundus photography CPT 92250 • Ophthalmology | $19 | $19 | $19 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $62 | $74 | $86 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $52 | $58 | $64 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $70 | $77 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,283 | $2,283 | $2,283 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $344 | $1,252 | $2,159 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,897 | $1,897 | $1,897 |