| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $367 | $367 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $22 | $22 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $69 | $70 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $100 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $159 | $161 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $141 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $55 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $64 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $92 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $171 | $173 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $86 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $131 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $173 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $88 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $74 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $91 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $75 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $119 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $61 | $92 |
| Consultation office high complexity CPT 99245 • Office Visits | $202 | $228 | $255 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $483 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $30 | $30 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $30 | $30 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $70 | $109 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $30 | $30 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $30 | $30 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $30 | $30 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $566 | $669 | $772 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $74 | $98 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $60 | $60 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $39 | $39 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $30 | $30 |
| Fundus photography CPT 92250 • Ophthalmology | $30 | $30 | $30 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $30 | $30 | $30 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $63 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,800 | $1,800 | $1,801 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |