| Office visit new patient high complexity CPT 99205 • Office Visits | $306 | $352 | $416 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $29 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $73 | $93 | $129 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $90 | $122 | $151 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $176 | $187 | $207 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $236 | $271 | $328 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $138 | $164 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $186 | $236 | $297 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $273 | $333 | $395 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $52 | $76 | $112 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $98 | $133 | $181 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $141 | $193 | $269 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $99 | $134 | $185 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $145 | $194 | $261 |
| Consultation office low complexity CPT 99243 • Office Visits | $166 | $184 | $200 |
| Consultation office high complexity CPT 99245 • Office Visits | $303 | $359 | $409 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $862 | $945 | $1,023 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $58 | $86 | $107 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,615 | $1,940 | $2,207 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $342 | $556 | $913 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,504 | $2,196 | $3,241 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $697 | $908 | $1,081 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $418 | $453 | $500 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,025 | $1,891 | $3,311 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $748 | $1,145 | $1,612 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $157 | $201 | $274 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $492 | $1,384 | $2,023 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $713 | $838 | $931 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $471 | $649 | $900 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $822 | $894 | $1,004 |
| Excision chalazion single CPT 67800 • Ophthalmology | $179 | $195 | $215 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,103 | $1,169 | $1,289 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $208 | $225 | $248 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $120 | $150 | $195 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $209 | $223 | $245 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $115 | $127 | $143 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $176 | $224 | $290 |
| Visual field examination CPT 92083 • Ophthalmology | $51 | $72 | $103 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $22 | $43 | $67 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $34 | $72 | $113 |
| Fundus photography CPT 92250 • Ophthalmology | $25 | $78 | $128 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $72 | $89 | $114 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $74 | $78 | $85 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $78 | $86 | $92 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,365 | $4,529 | $8,367 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $723 | $1,866 | $2,665 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $830 | $2,170 | $3,107 |
| Total shoulder replacement CPT 23472 • Orthopedics | $749 | $1,740 | $2,453 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,253 | $3,398 | $5,203 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $587 | $1,107 | $2,032 |