| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $20 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $49 | $54 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $65 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $70 | $102 | $124 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $157 | $167 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $103 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $116 | $136 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $155 | $200 | $248 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $72 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $104 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $106 | $126 | $144 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $92 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $111 | $129 |
| Consultation office low complexity CPT 99243 • Office Visits | $100 | $100 | $100 |
| Consultation office high complexity CPT 99245 • Office Visits | $187 | $187 | $187 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $462 | $610 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $35 | $35 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,042 | $1,086 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $216 | $231 | $245 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $961 | $961 | $961 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $442 | $442 | $442 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $208 | $252 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $657 | $660 | $663 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $355 | $452 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $81 | $126 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,050 | $1,121 | $1,192 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $438 | $477 | $515 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $300 | $328 | $357 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $401 | $401 | $401 |
| Excision chalazion single CPT 67800 • Ophthalmology | $113 | $117 | $121 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $698 | $698 | $698 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $103 | $152 | $201 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $67 | $67 | $67 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $118 | $132 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $71 | $79 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $62 | $93 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $27 | $44 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $20 | $28 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $13 | $21 | $29 |
| Fundus photography CPT 92250 • Ophthalmology | $29 | $33 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $41 | $46 | $51 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $43 | $48 | $53 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $52 | $59 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $1,287 | $1,943 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,808 | $1,808 | $1,808 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,064 | $2,064 | $2,064 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,647 | $1,647 | $1,647 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,835 | $1,835 | $1,835 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $444 | $476 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $385 | $385 | $385 |