| Initial hospital care moderate complexity CPT 99222 • Office Visits | $98 | $98 | $98 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $131 | $131 | $132 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $37 | $37 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $60 | $60 | $60 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $89 | $89 | $89 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $61 | $61 | $61 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $87 | $87 | $87 |
| Consultation office low complexity CPT 99243 • Office Visits | $104 | $104 | $104 |
| Consultation office high complexity CPT 99245 • Office Visits | $193 | $193 | $194 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $39 | $39 | $39 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $212 | $212 | $212 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $526 | $526 | $526 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $307 | $307 | $307 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $352 | $352 | $352 |
| Excision chalazion single CPT 67800 • Ophthalmology | $106 | $106 | $106 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $819 | $819 | $819 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $79 | $79 | $79 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $140 | $140 | $140 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $34 | $34 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $16 | $16 | $16 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $44 | $44 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $19 | $19 | $19 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $58 | $58 | $59 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,639 | $1,639 | $1,639 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $309 | $309 | $309 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $272 | $272 | $272 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,117 | $1,117 | $1,117 |
| Total knee replacement CPT 27447 • Orthopedics | $1,165 | $1,165 | $1,165 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $544 | $544 | $544 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $792 | $792 | $792 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $499 | $499 | $499 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $148 | $148 | $148 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $93 | $93 | $93 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $222 | $222 | $222 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $43 | $43 | $43 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $212 | $212 | $212 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $154 | $154 | $154 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $79 | $79 | $79 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $379 | $379 | $379 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $203 | $203 | $204 |
| Cytopathology concentration technique CPT 88108 • Pathology | $44 | $44 | $44 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $43 | $43 | $43 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $17 | $17 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $182 | $182 | $182 |