| Office visit new patient straightforward CPT 99202 • Office Visits | $38 | $60 | $82 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $43 | $79 | $116 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $48 | $120 | $176 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $201 | $222 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $22 | $25 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $38 | $50 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $37 | $59 | $81 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $48 | $94 | $117 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $157 | $157 | $157 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $56 | $100 | $144 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $62 | $105 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $71 | $149 | $217 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $35 | $64 | $92 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $40 | $67 | $95 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $47 | $79 | $112 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $92 | $92 | $92 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $116 | $116 | $116 |
| Consultation office low complexity CPT 99243 • Office Visits | $79 | $110 | $142 |
| Consultation office high complexity CPT 99245 • Office Visits | $242 | $242 | $242 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $479 | $479 | $479 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $39 | $39 | $39 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,174 | $1,174 | $1,174 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $205 | $205 | $205 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $237 | $237 | $237 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $744 | $744 | $744 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $543 | $543 | $543 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $114 | $114 | $114 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,185 | $1,185 | $1,185 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $518 | $518 | $518 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $341 | $341 | $341 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $484 | $484 | $484 |
| Excision chalazion single CPT 67800 • Ophthalmology | $102 | $102 | $102 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $815 | $815 | $815 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $151 | $151 | $151 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $58 | $58 | $58 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $63 | $63 | $63 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $34 | $34 | $34 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $51 | $51 | $51 |
| Visual field examination CPT 92083 • Ophthalmology | $24 | $24 | $24 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $11 | $11 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $33 | $33 | $33 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $14 | $14 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $45 | $45 | $45 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $31 | $31 | $31 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $55 | $55 | $55 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,378 | $1,378 | $1,378 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,295 | $1,295 | $1,295 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,502 | $1,502 | $1,502 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,200 | $1,200 | $1,200 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $292 | $292 | $292 |