| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $65 | $76 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $102 | $112 | $122 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $138 | $155 | $172 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $185 | $214 | $243 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $92 | $92 | $92 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $148 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $198 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $56 | $56 | $56 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $72 | $72 | $72 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $92 | $92 | $92 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $66 | $66 | $66 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $146 | $146 | $146 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $829 | $829 | $829 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,564 | $1,564 | $1,564 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $715 | $715 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $720 | $720 | $720 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $604 | $604 | $604 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $57 | $64 | $72 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $62 | $68 | $73 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $75 | $86 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,538 | $1,880 | $2,223 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,790 | $1,850 | $1,911 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $465 | $465 | $465 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $314 | $546 | $778 |
| Total hip replacement CPT 27130 • Orthopedics | $1,698 | $1,698 | $1,698 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $2,205 | $2,205 | $2,205 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,311 | $1,467 | $1,624 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,520 | $1,520 | $1,520 |
| Total knee replacement CPT 27447 • Orthopedics | $1,590 | $1,643 | $1,695 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,172 | $1,172 | $1,172 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $161 | $193 | $225 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,067 | $1,243 | $1,419 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $602 | $677 | $752 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $673 | $699 | $724 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $699 | $809 | $919 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,041 | $1,168 | $1,294 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $944 | $946 | $949 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,124 | $1,289 | $1,454 |
| Carpal tunnel release CPT 64721 • Orthopedics | $457 | $526 | $596 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $110 | $110 | $110 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $113 | $113 | $113 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $105 | $105 | $105 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $21 | $48 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $41 | $41 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $109 | $109 | $109 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $49 | $49 | $49 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $143 | $143 | $143 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $81 | $81 | $81 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $139 | $139 | $139 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $304 | $304 | $304 |