| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $93 | $142 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $151 | $230 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $102 | $214 | $327 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $143 | $163 | $184 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $135 | $193 | $251 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $132 | $133 | $135 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $174 | $182 | $190 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $81 | $88 | $95 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $81 | $130 | $179 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $98 | $109 | $119 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $81 | $81 | $82 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $101 | $183 | $265 |
| Consultation office low complexity CPT 99243 • Office Visits | $134 | $186 | $238 |
| Consultation office high complexity CPT 99245 • Office Visits | $182 | $188 | $195 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $478 | $505 | $531 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $44 | $59 | $73 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,015 | $1,167 | $1,319 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $279 | $280 | $280 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,228 | $1,556 | $1,884 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $569 | $805 | $1,040 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $341 | $377 | $412 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $641 | $739 | $837 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $611 | $693 | $774 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $128 | $269 | $409 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $259 | $797 | $1,335 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $582 | $802 | $1,021 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $384 | $399 | $413 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $623 | $647 | $671 |
| Excision chalazion single CPT 67800 • Ophthalmology | $140 | $142 | $145 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $586 | $749 | $912 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $160 | $165 | $170 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $79 | $82 | $86 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $138 | $144 | $150 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $82 | $86 | $90 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $116 | $124 | $131 |
| Visual field examination CPT 92083 • Ophthalmology | $58 | $63 | $67 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $27 | $37 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $50 | $67 | $84 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $47 | $59 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $53 | $60 | $66 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $51 | $53 | $55 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $52 | $65 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $473 | $1,108 | $1,743 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $356 | $992 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $358 | $1,126 | $1,895 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,488 | $2,255 | $3,021 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $396 | $1,028 | $1,659 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $369 | $401 | $432 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $260 | $305 | $350 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $414 | $514 | $613 |