| Office visit established patient straightforward CPT 99212 • Office Visits | $58 | $69 | $80 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $86 | $89 | $92 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $4 | $31 | $58 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $6 | $69 | $133 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $3 | $30 | $58 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $4 | $31 | $58 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $5 | $31 | $58 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $58 | $63 | $69 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $2 | $30 | $58 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $4 | $67 | $130 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $3 | $30 | $58 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $4 | $64 | $125 |
| Consultation office low complexity CPT 99243 • Office Visits | $4 | $49 | $94 |
| Consultation office high complexity CPT 99245 • Office Visits | $7 | $183 | $360 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $888 | $914 | $941 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $54 | $54 | $54 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $37 | $972 | $1,907 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $8 | $203 | $397 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $34 | $899 | $1,764 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $715 | $715 | $715 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $9 | $246 | $482 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $23 | $614 | $1,204 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $763 | $985 | $1,207 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $4 | $94 | $184 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $37 | $979 | $1,921 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $728 | $780 | $833 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $10 | $279 | $549 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $640 | $640 | $640 |
| Excision chalazion single CPT 67800 • Ophthalmology | $4 | $106 | $209 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $830 | $830 | $830 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $5 | $121 | $237 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $64 | $96 | $129 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $5 | $118 | $231 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $71 | $103 | $135 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $4 | $98 | $193 |
| Visual field examination CPT 92083 • Ophthalmology | $52 | $71 | $90 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $58 | $60 | $62 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $67 | $81 | $95 |
| Fundus photography CPT 92250 • Ophthalmology | $53 | $55 | $58 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $75 | $77 | $78 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $58 | $68 | $78 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $58 | $75 | $92 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $53 | $1,282 | $2,511 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $50 | $1,603 | $3,157 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $57 | $1,363 | $2,669 |
| Total shoulder replacement CPT 23472 • Orthopedics | $46 | $1,096 | $2,146 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $51 | $51 | $51 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $601 | $601 | $601 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $10 | $260 | $511 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $10 | $521 | $1,032 |