| Office visit new patient high complexity CPT 99205 • Office Visits | $18 | $128 | $215 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $27 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $23 | $46 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $45 | $74 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $95 | $112 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $128 | $160 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $91 | $144 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $125 | $155 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $184 | $194 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $99 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $109 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $97 | $118 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $69 | $109 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $99 | $119 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $98 | $138 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $107 | $150 | $194 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $663 | $663 | $663 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $18 | $42 | $67 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,169 | $1,208 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $327 | $327 | $327 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,105 | $1,105 | $1,105 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $535 | $588 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $426 | $426 | $426 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,012 | $1,012 | $1,012 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $521 | $621 | $720 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $162 | $162 | $162 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $894 | $1,512 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $652 | $652 | $652 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $327 | $712 | $1,097 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $559 | $559 | $559 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $76 | $121 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $345 | $620 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $144 | $144 | $144 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $44 | $44 | $44 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $92 | $92 | $92 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $46 | $46 | $46 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $71 | $71 | $71 |
| Visual field examination CPT 92083 • Ophthalmology | $50 | $55 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $32 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $53 | $53 | $53 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $19 | $23 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $51 | $54 | $57 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $53 | $57 | $61 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $30 | $52 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,818 | $2,145 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,634 | $1,634 | $1,634 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $2,056 | $2,311 |
| Total shoulder replacement CPT 23472 • Orthopedics | $283 | $927 | $1,571 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,059 | $2,059 | $2,059 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $427 | $456 |