| Subsequent hospital care high complexity CPT 99233 • Office Visits | $109 | $109 | $109 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $76 | $76 | $76 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $112 | $112 | $113 |
| Consultation office low complexity CPT 99243 • Office Visits | $40 | $83 | $127 |
| Consultation office high complexity CPT 99245 • Office Visits | $232 | $232 | $232 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $492 | $492 | $492 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $29 | $29 | $29 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $184 | $184 | $184 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $811 | $811 | $811 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $37 | $206 | $374 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $40 | $40 | $40 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $384 | $384 | $384 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $25 | $140 | $254 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $444 | $444 | $444 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $596 | $596 | $596 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $59 | $59 | $59 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $17 | $17 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $37 | $37 | $37 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $39 | $39 | $39 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $50 | $50 | $50 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,490 | $1,490 | $1,490 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,371 | $1,371 | $1,371 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,610 | $1,610 | $1,610 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $255 | $255 | $255 |
| Total hip replacement CPT 27130 • Orthopedics | $1,149 | $1,149 | $1,149 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,419 | $1,419 | $1,419 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,010 | $1,010 | $1,010 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $980 | $980 | $980 |
| Total knee replacement CPT 27447 • Orthopedics | $1,147 | $1,147 | $1,148 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $484 | $484 | $484 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $742 | $742 | $742 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $150 | $150 | $150 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $883 | $883 | $883 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $471 | $471 | $471 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $453 | $453 | $453 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $40 | $40 | $40 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $838 | $838 | $838 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $953 | $953 | $953 |
| Carpal tunnel release CPT 64721 • Orthopedics | $356 | $356 | $356 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $128 | $128 | $128 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $195 | $195 | $195 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $39 | $39 | $39 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $174 | $174 | $174 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $74 | $74 | $74 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $137 | $137 | $137 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $69 | $69 | $69 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $125 | $125 | $125 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $331 | $331 | $332 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $136 | $136 | $136 |
| Cytopathology concentration technique CPT 88108 • Pathology | $43 | $43 | $43 |