| Office visit established patient straightforward CPT 99212 • Office Visits | $57 | $57 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $91 | $91 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $110 | $110 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $182 | $182 | $182 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $85 | $85 | $85 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $134 | $134 | $134 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $152 | $165 | $178 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $51 | $51 | $51 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $81 | $81 | $81 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $122 | $122 | $122 |
| 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 | $100 | $109 | $117 |
| Consultation office low complexity CPT 99243 • Office Visits | $81 | $101 | $121 |
| Consultation office high complexity CPT 99245 • Office Visits | $193 | $209 | $226 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $50 | $50 | $50 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,521 | $1,521 | $1,521 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $648 | $648 | $648 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,532 | $1,532 | $1,532 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $438 | $438 | $438 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,025 | $1,025 | $1,025 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $150 | $150 | $150 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $97 | $97 | $97 |
| Visual field examination CPT 92083 • Ophthalmology | $39 | $39 | $39 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $17 | $17 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $18 | $18 | $18 |
| Fundus photography CPT 92250 • Ophthalmology | $42 | $42 | $42 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $81 | $81 | $81 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,343 | $2,343 | $2,343 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,571 | $1,571 | $1,571 |
| Total knee replacement CPT 27447 • Orthopedics | $1,645 | $1,645 | $1,645 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $740 | $740 | $740 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $370 | $370 | $370 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,096 | $1,096 | $1,096 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $221 | $221 | $221 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $693 | $693 | $693 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $202 | $202 | $202 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $318 | $318 | $318 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $62 | $62 | $62 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $304 | $304 | $304 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $218 | $218 | $218 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $113 | $113 | $113 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $546 | $546 | $546 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $296 | $296 | $296 |
| Cytopathology concentration technique CPT 88108 • Pathology | $20 | $20 | $20 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $34 | $34 | $34 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $20 | $20 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $25 | $25 | $25 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $29 | $29 | $29 |