| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $134 | $215 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $49 | $173 | $311 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $49 | $216 | $403 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $44 | $228 | $441 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $41 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $41 | $71 | $108 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $88 | $168 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $44 | $144 | $309 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $49 | $229 | $413 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $161 | $285 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $49 | $176 | $312 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $49 | $282 | $485 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $32 | $59 | $89 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $49 | $92 | $155 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $156 | $237 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $78 | $129 | $174 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $189 | $303 |
| Consultation office straightforward CPT 99241 • Office Visits | $120 | $120 | $120 |
| Consultation office low complexity CPT 99243 • Office Visits | $120 | $197 | $311 |
| Consultation office high complexity CPT 99245 • Office Visits | $185 | $339 | $544 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $614 | $960 | $1,412 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $34 | $62 | $111 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,092 | $1,963 | $2,925 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $245 | $361 | $558 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $812 | $1,787 | $3,591 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $906 | $1,879 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $293 | $525 | $895 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $665 | $1,034 | $1,695 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $508 | $1,001 | $1,934 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $173 | $212 | $305 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,379 | $2,317 | $4,083 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $515 | $909 | $1,508 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $327 | $936 | $2,855 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $458 | $978 | $1,818 |
| Excision chalazion single CPT 67800 • Ophthalmology | $74 | $202 | $328 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $493 | $907 | $1,389 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $86 | $219 | $335 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $38 | $113 | $190 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $72 | $250 | $437 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $30 | $122 | $215 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $48 | $199 | $311 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $78 | $192 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $16 | $37 | $62 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $13 | $60 | $140 |
| Fundus photography CPT 92250 • Ophthalmology | $22 | $46 | $62 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $34 | $60 | $122 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $35 | $93 | $145 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $78 | $180 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $287 | $2,578 | $4,228 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $2,040 | $3,290 | $4,634 |