| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $412 | $412 | $412 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $106 | $106 | $106 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $154 | $154 | $154 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $93 | $93 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $85 | $85 | $85 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $107 | $107 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $168 | $168 | $168 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $272 | $272 | $272 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $108 | $108 | $108 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $107 | $137 | $167 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $173 | $176 | $180 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $45 | $45 | $45 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $75 | $75 | $75 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $110 | $110 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $148 | $148 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $16 | $16 | $16 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $109 | $110 |
| Consultation office low complexity CPT 99243 • Office Visits | $131 | $131 | $131 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $126 | $230 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $534 | $534 | $534 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $38 | $38 | $38 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,056 | $1,056 | $1,056 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $486 | $486 | $487 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $499 | $499 | $499 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $329 | $329 | $329 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $466 | $466 | $466 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $779 | $779 | $779 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $75 | $75 | $75 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $44 | $44 | $44 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $111 | $111 | $111 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $13 | $13 | $13 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $43 | $43 | $43 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $18 | $18 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $50 | $50 | $50 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $42 | $42 | $42 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,579 | $1,579 | $1,579 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,473 | $1,473 | $1,473 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,718 | $1,718 | $1,718 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $391 | $391 | $391 |
| Total hip replacement CPT 27130 • Orthopedics | $1,193 | $1,193 | $1,193 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,552 | $1,552 | $1,552 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,109 | $1,109 | $1,109 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,072 | $1,072 | $1,072 |
| Total knee replacement CPT 27447 • Orthopedics | $1,192 | $1,192 | $1,192 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $540 | $540 | $540 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $820 | $820 | $821 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $994 | $994 | $994 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $523 | $523 | $523 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $504 | $504 | $504 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $895 | $895 | $895 |