| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $332 | $332 | $332 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $501 | $501 | $501 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $114 | $114 | $114 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $165 | $165 | $165 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $253 | $253 | $253 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $318 | $318 | $318 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $30 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $57 | $57 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $88 | $88 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $165 | $165 | $165 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $132 | $132 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $157 | $157 | $157 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $213 | $213 | $213 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $315 | $315 | $315 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $129 | $129 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $129 | $129 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $129 | $129 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $129 | $129 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $129 | $129 | $129 |
| Consultation office low complexity CPT 99243 • Office Visits | $191 | $191 | $191 |
| Consultation office high complexity CPT 99245 • Office Visits | $348 | $348 | $348 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $650 | $796 | $942 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $60 | $355 | $650 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $650 | $660 | $670 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $457 | $554 | $650 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $650 | $739 | $827 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $586 | $618 | $650 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $457 | $466 | $475 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $650 | $964 | $1,278 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $650 | $964 | $1,278 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $457 | $466 | $475 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $650 | $979 | $1,307 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $457 | $554 | $650 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $457 | $466 | $475 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $650 | $660 | $670 |
| Excision chalazion single CPT 67800 • Ophthalmology | $457 | $466 | $475 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $650 | $796 | $942 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $60 | $268 | $475 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $137 | $137 | $137 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $251 | $251 | $251 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $144 | $144 | $144 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $209 | $209 | $209 |
| Visual field examination CPT 92083 • Ophthalmology | $108 | $108 | $108 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $76 | $76 | $76 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $151 | $151 | $151 |
| Fundus photography CPT 92250 • Ophthalmology | $132 | $132 | $132 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $457 | $466 | $475 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $457 | $466 | $475 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $457 | $466 | $475 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $650 | $660 | $670 |