| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $314 | $314 | $314 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $65 | $65 | $65 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $101 | $101 | $101 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $151 | $151 | $151 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $199 | $199 | $200 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $21 | $21 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $51 | $51 | $51 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $82 | $82 | $83 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $116 | $116 | $116 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $163 | $163 | $163 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $72 | $72 | $73 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $115 | $115 | $115 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $153 | $153 | $154 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $70 | $70 | $70 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $104 | $104 | $105 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $72 | $72 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $102 | $102 |
| Consultation office low complexity CPT 99243 • Office Visits | $94 | $94 | $95 |
| Consultation office high complexity CPT 99245 • Office Visits | $175 | $175 | $176 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $637 | $637 | $637 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $45 | $45 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,292 | $1,292 | $1,293 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $602 | $602 | $602 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $642 | $642 | $642 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $134 | $134 | $134 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,396 | $1,396 | $1,396 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $608 | $608 | $609 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $400 | $400 | $401 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $540 | $540 | $540 |
| Excision chalazion single CPT 67800 • Ophthalmology | $155 | $155 | $155 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $940 | $940 | $941 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $93 | $93 | $93 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $101 | $101 | $101 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $54 | $76 | $98 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $139 | $139 | $139 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $16 | $26 | $36 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $52 | $52 | $52 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $29 | $41 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $8 | $32 | $55 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $65 | $65 | $65 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,682 | $1,682 | $1,682 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,568 | $1,568 | $1,568 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,793 | $1,793 | $1,793 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,440 | $1,440 | $1,440 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,600 | $1,600 | $1,600 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $425 | $425 | $425 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $347 | $347 | $347 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $597 | $597 | $597 |
| Total hip replacement CPT 27130 • Orthopedics | $1,280 | $1,280 | $1,280 |