| Office visit new patient moderate complexity CPT 99204 • Office Visits | $213 | $286 | $375 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $272 | $347 | $495 |
| Office visit established patient minimal CPT 99211 • Office Visits | $29 | $38 | $51 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $73 | $126 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $94 | $139 | $204 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $143 | $202 | $287 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $205 | $281 | $404 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $154 | $167 | $184 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $209 | $241 | $291 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $300 | $338 | $388 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $63 | $80 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $111 | $135 | $177 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $166 | $199 | $264 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $115 | $138 | $181 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $168 | $199 | $256 |
| Consultation office low complexity CPT 99243 • Office Visits | $158 | $184 | $198 |
| Consultation office high complexity CPT 99245 • Office Visits | $285 | $324 | $379 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $550 | $575 | $601 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $68 | $98 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,393 | $1,657 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $395 | $466 | $537 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,047 | $1,277 | $1,508 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $627 | $772 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $288 | $355 | $421 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $727 | $1,182 | $1,638 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $319 | $757 | $1,196 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $249 | $267 | $284 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,141 | $1,495 | $1,849 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $495 | $619 | $744 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $326 | $742 | $1,159 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $596 | $801 | $1,005 |
| Excision chalazion single CPT 67800 • Ophthalmology | $123 | $137 | $151 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $566 | $819 | $1,072 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $147 | $232 | $316 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $61 | $127 | $186 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $61 | $184 | $329 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $61 | $132 | $195 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $180 | $277 |
| Visual field examination CPT 92083 • Ophthalmology | $29 | $92 | $139 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $13 | $44 | $71 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $51 | $70 | $104 |
| Fundus photography CPT 92250 • Ophthalmology | $39 | $53 | $81 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $73 | $96 | $119 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $87 | $104 | $121 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $109 | $126 | $143 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $2,483 | $3,312 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,545 | $2,099 | $2,653 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,800 | $2,710 | $3,621 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,414 | $1,987 | $2,561 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $2,327 | $3,079 |