| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $64 | $77 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $101 | $105 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $56 | $108 |
| Consultation office high complexity CPT 99245 • Office Visits | $202 | $203 | $204 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $618 | $688 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $45 | $45 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,399 | $1,399 | $1,399 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $237 | $302 | $368 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $666 | $1,302 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $605 | $605 | $605 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $226 | $261 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $731 | $747 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $269 | $508 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $75 | $119 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $30 | $30 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $387 | $616 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $357 | $389 | $406 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $541 | $541 | $541 |
| Excision chalazion single CPT 67800 • Ophthalmology | $87 | $105 | $123 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $106 | $536 | $966 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $42 | $42 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $147 | $147 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $40 | $64 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $50 | $83 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $62 | $62 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $24 | $31 | $44 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $37 | $51 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $26 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $35 | $35 | $35 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $22 | $36 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $61 | $63 | $64 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $993 | $1,721 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,592 | $1,592 | $1,592 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,824 | $1,824 | $1,824 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,586 | $1,596 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $415 | $417 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $317 | $317 | $317 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Total hip replacement CPT 27130 • Orthopedics | $1,275 | $1,275 | $1,275 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,657 | $1,657 | $1,657 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $608 | $1,186 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $900 | $900 | $900 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $586 | $1,141 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $652 | $1,274 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $580 | $580 | $581 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $157 | $284 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $451 | $872 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $547 | $1,064 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $564 | $564 | $564 |