| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $72 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $107 | $107 | $107 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $165 | $165 | $165 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $45 | $45 | $45 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $19 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $38 | $38 | $38 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $65 | $65 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $104 | $104 | $104 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $140 | $140 | $140 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $146 | $146 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $146 | $146 | $146 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $185 | $185 | $185 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $64 | $64 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $65 | $65 | $65 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $94 | $94 | $94 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $66 | $66 | $66 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $97 | $97 |
| Consultation office low complexity CPT 99243 • Office Visits | $124 | $124 | $124 |
| Consultation office high complexity CPT 99245 • Office Visits | $185 | $185 | $185 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $512 | $512 | $512 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $30 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $915 | $915 | $915 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $192 | $192 | $192 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $850 | $850 | $850 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $392 | $392 | $392 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $234 | $234 | $234 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $580 | $580 | $580 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $423 | $423 | $423 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $88 | $88 | $88 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $927 | $927 | $927 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $402 | $402 | $402 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $266 | $266 | $266 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $465 | $465 | $465 |
| Excision chalazion single CPT 67800 • Ophthalmology | $100 | $100 | $100 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $627 | $627 | $627 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $116 | $116 | $116 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $62 | $62 | $62 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $107 | $107 | $107 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $64 | $64 | $64 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $90 | $90 | $90 |
| Visual field examination CPT 92083 • Ophthalmology | $45 | $45 | $45 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $29 | $29 | $29 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $39 | $39 | $39 |
| Fundus photography CPT 92250 • Ophthalmology | $28 | $28 | $28 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $40 | $40 | $40 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $43 | $43 | $43 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $52 | $52 | $52 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,617 | $1,617 | $1,617 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,473 | $1,473 | $1,473 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,736 | $1,736 | $1,736 |