| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $172 | $172 | $172 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $279 | $279 | $279 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $77 | $77 | $77 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $30 | $30 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $179 | $195 | $211 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $30 | $30 |
| 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 | $30 | $65 | $101 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $30 | $30 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $208 | $208 | $208 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $30 | $30 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $30 | $30 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $110 | $110 | $110 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $30 | $30 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $21 | $21 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,128 | $1,128 | $1,128 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $30 | $30 | $30 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $481 | $481 | $482 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $30 | $30 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $30 | $30 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $30 | $30 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $585 | $1,139 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $326 | $326 | $326 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $64 | $97 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $771 | $771 | $771 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $112 | $112 | $112 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $85 | $85 | $85 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $121 | $121 | $121 |
| Visual field examination CPT 92083 • Ophthalmology | $25 | $25 | $25 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $38 | $38 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $30 | $30 |
| Fundus photography CPT 92250 • Ophthalmology | $30 | $30 | $30 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $30 | $30 | $30 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $30 | $32 | $33 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $30 | $44 | $58 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,528 | $1,528 | $1,528 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,663 | $1,663 | $1,663 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,301 | $1,301 | $1,301 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,451 | $1,451 | $1,451 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $379 | $379 | $379 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $30 | $30 | $30 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $30 | $30 |