| Office visit new patient straightforward CPT 99202 • Office Visits | $82 | $186 | $265 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $134 | $243 | $373 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $213 | $466 | $564 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $272 | $526 | $752 |
| Office visit established patient minimal CPT 99211 • Office Visits | $29 | $57 | $77 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $120 | $189 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $94 | $198 | $303 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $143 | $285 | $432 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $205 | $413 | $614 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $154 | $203 | $254 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $209 | $289 | $403 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $291 | $392 | $537 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $63 | $103 | $152 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $111 | $170 | $245 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $166 | $258 | $367 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $115 | $175 | $251 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $168 | $253 | $355 |
| Consultation office low complexity CPT 99243 • Office Visits | $155 | $180 | $198 |
| Consultation office high complexity CPT 99245 • Office Visits | $254 | $312 | $379 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $290 | $550 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $64 | $98 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,393 | $1,657 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $395 | $640 | $780 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,508 | $2,608 | $3,327 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $627 | $772 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $226 | $421 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $727 | $1,670 | $2,270 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $319 | $1,151 | $1,657 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $284 | $331 | $363 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,141 | $1,495 | $1,849 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $387 | $744 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $594 | $1,159 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $529 | $596 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $90 | $151 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $551 | $1,072 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $147 | $347 | $454 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $61 | $160 | $270 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $61 | $280 | $479 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $61 | $180 | $288 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $237 | $406 |
| Visual field examination CPT 92083 • Ophthalmology | $29 | $118 | $202 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $13 | $67 | $104 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $51 | $91 | $153 |
| Fundus photography CPT 92250 • Ophthalmology | $39 | $88 | $129 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $73 | $138 | $177 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $87 | $145 | $180 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $109 | $174 | $216 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $2,483 | $3,312 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $1,341 | $2,653 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,800 | $2,710 | $3,621 |