| Office visit new patient high complexity CPT 99205 • Office Visits | $261 | $261 | $261 |
| Office visit established patient minimal CPT 99211 • Office Visits | $50 | $50 | $50 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $57 | $57 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $93 | $93 | $93 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $8 | $8 | $8 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $183 | $183 | $183 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $127 | $127 | $127 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $172 | $172 | $172 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $254 | $254 | $254 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $80 | $80 | $80 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $91 | $91 | $91 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $130 | $130 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $92 | $92 | $92 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $135 | $135 | $135 |
| Consultation office low complexity CPT 99243 • Office Visits | $109 | $132 | $155 |
| Consultation office high complexity CPT 99245 • Office Visits | $281 | $281 | $281 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $698 | $698 | $698 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $371 | $371 | $371 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $50 | $50 | $50 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $151 | $151 | $151 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,331 | $1,331 | $1,331 |
| Excision chalazion single CPT 67800 • Ophthalmology | $119 | $119 | $119 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $832 | $832 | $832 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $34 | $34 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $19 | $19 | $19 |
| Fundus photography CPT 92250 • Ophthalmology | $93 | $93 | $93 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $70 | $70 | $70 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $65 | $71 | $76 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,473 | $2,473 | $2,473 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,966 | $1,966 | $1,966 |
| Total knee replacement CPT 27447 • Orthopedics | $2,025 | $2,025 | $2,025 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $746 | $746 | $746 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $920 | $920 | $920 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $843 | $843 | $843 |
| Carpal tunnel release CPT 64721 • Orthopedics | $505 | $505 | $505 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $246 | $246 | $246 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $303 | $303 | $303 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $292 | $292 | $292 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $534 | $534 | $534 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $225 | $225 | $225 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $177 | $177 | $177 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $96 | $96 | $96 |
| Microdissection manual CPT 88381 • Pathology | $144 | $144 | $144 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $13 | $13 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $16 | $16 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $16 | $16 | $16 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $27 | $27 |