| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $59 | $59 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $87 | $87 | $87 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $134 | $134 | $134 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $139 | $139 | $139 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $19 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $21 | $21 | $21 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $57 | $57 | $57 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $86 | $86 | $86 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $117 | $117 | $117 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $82 | $82 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $115 | $115 | $115 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $169 | $169 | $169 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $35 | $35 | $35 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $62 | $62 | $62 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $89 | $89 | $89 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $63 | $63 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $92 | $92 | $92 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $116 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $178 | $178 | $178 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $641 | $641 | $641 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $54 | $54 | $54 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,251 | $1,251 | $1,251 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $353 | $353 | $353 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,170 | $1,170 | $1,170 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $621 | $621 | $621 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $453 | $453 | $453 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,077 | $1,077 | $1,077 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $769 | $769 | $769 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $224 | $224 | $224 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,610 | $1,610 | $1,610 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $667 | $667 | $667 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $969 | $969 | $969 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $594 | $594 | $594 |
| Excision chalazion single CPT 67800 • Ophthalmology | $130 | $130 | $130 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $613 | $613 | $613 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $155 | $155 | $155 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $21 | $21 | $21 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $40 | $40 | $40 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $17 | $17 | $17 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $43 | $43 | $43 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $34 | $34 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $8 | $8 | $8 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $13 | $13 | $13 |
| Fundus photography CPT 92250 • Ophthalmology | $11 | $11 | $11 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $45 | $45 | $45 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $64 | $64 | $64 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $55 | $55 | $55 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,221 | $2,221 | $2,221 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,734 | $1,734 | $1,734 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,394 | $2,394 | $2,394 |