| 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 | $25 | $55 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $32 | $70 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $54 | $91 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $90 | $180 | $270 |
| Office visit established patient minimal CPT 99211 • Office Visits | $25 | $28 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $49 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $25 | $51 | $97 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $70 | $140 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $55 | $122 | $188 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $96 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $88 | $129 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $66 | $154 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $90 | $110 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $88 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $67 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $96 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $132 | $135 |
| Consultation office straightforward CPT 99241 • Office Visits | $95 | $95 | $95 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $48 | $66 |
| Consultation office high complexity CPT 99245 • Office Visits | $105 | $180 | $255 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $483 | $483 |
| 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 | $586 | $1,141 |
| 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 | $772 | $772 | $772 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $49 | $68 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $122 | $122 | $122 |
| 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 | $1,801 | $1,801 | $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 |
| 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 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $30 | $30 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $642 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $30 | $30 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $30 | $30 |