| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $82 | $82 | $82 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $110 | $110 | $110 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $82 | $82 | $82 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $96 | $105 | $113 |
| Consultation office low complexity CPT 99243 • Office Visits | $12 | $17 | $21 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $130 | $238 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $589 | $589 | $589 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $47 | $47 | $47 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,424 | $1,424 | $1,424 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,322 | $1,322 | $1,322 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $610 | $610 | $610 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $625 | $625 | $625 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $412 | $412 | $412 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $583 | $583 | $583 |
| Excision chalazion single CPT 67800 • Ophthalmology | $21 | $21 | $21 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $715 | $847 | $979 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $98 | $98 | $98 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $144 | $144 | $144 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $28 | $28 | $28 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $56 | $56 | $56 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $68 | $68 | $68 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,847 | $1,847 | $1,847 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,711 | $1,711 | $1,711 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,004 | $2,004 | $2,004 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $21 | $21 | $21 |
| Total hip replacement CPT 27130 • Orthopedics | $1,367 | $1,367 | $1,367 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,779 | $1,779 | $1,779 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,270 | $1,270 | $1,270 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,307 | $1,307 | $1,307 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,306 | $1,306 | $1,306 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,229 | $1,229 | $1,229 |
| Total knee replacement CPT 27447 • Orthopedics | $1,366 | $1,366 | $1,366 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $617 | $617 | $618 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $923 | $923 | $924 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,137 | $1,137 | $1,137 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $598 | $598 | $598 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $576 | $576 | $576 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $981 | $981 | $981 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,112 | $1,112 | $1,112 |
| Carpal tunnel release CPT 64721 • Orthopedics | $437 | $437 | $437 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $170 | $170 | $170 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $103 | $103 | $103 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $136 | $136 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $253 | $253 | $253 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $241 | $241 | $241 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $169 | $169 | $169 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $88 | $88 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $154 | $154 | $154 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $434 | $434 | $435 |