| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $92 | $92 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $138 | $138 | $138 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $174 | $174 | $174 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $46 | $47 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $74 | $74 | $75 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $101 | $103 | $106 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $148 | $148 | $148 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $69 | $69 | $69 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $109 | $109 | $109 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $137 | $141 | $145 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $41 | $41 | $41 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $66 | $66 | $66 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $99 | $99 | $100 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $67 | $67 | $68 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $91 | $93 | $95 |
| Consultation office low complexity CPT 99243 • Office Visits | $123 | $123 | $123 |
| Consultation office high complexity CPT 99245 • Office Visits | $229 | $241 | $253 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $670 | $670 | $670 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $48 | $48 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,356 | $1,356 | $1,357 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $625 | $625 | $626 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $676 | $676 | $676 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $114 | $128 | $141 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,478 | $1,478 | $1,478 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $640 | $640 | $641 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $409 | $415 | $422 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $565 | $565 | $565 |
| Excision chalazion single CPT 67800 • Ophthalmology | $161 | $161 | $161 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $964 | $964 | $964 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $181 | $181 | $181 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $91 | $91 | $91 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $128 | $128 | $128 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $20 | $30 | $41 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $47 | $47 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $16 | $27 | $38 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $41 | $52 | $63 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $72 | $72 | $72 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,931 | $1,931 | $1,931 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,053 | $2,053 | $2,053 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,839 | $1,839 | $1,839 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $483 | $483 | $483 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $335 | $502 | $670 |
| Total hip replacement CPT 27130 • Orthopedics | $1,466 | $1,466 | $1,466 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,905 | $1,905 | $1,905 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,362 | $1,362 | $1,362 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,401 | $1,401 | $1,402 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,400 | $1,400 | $1,400 |