| Office visit new patient low complexity CPT 99203 • Office Visits | $41 | $73 | $120 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $41 | $105 | $136 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $123 | $178 | $252 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $33 | $41 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $32 | $41 | $51 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $37 | $54 | $84 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $41 | $63 | $91 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $41 | $95 | $162 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $41 | $91 | $159 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $41 | $101 | $159 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $41 | $145 | $220 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $31 | $49 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $41 | $58 | $79 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $41 | $78 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $41 | $59 | $80 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $102 | $117 |
| Consultation office straightforward CPT 99241 • Office Visits | $41 | $41 | $41 |
| Consultation office low complexity CPT 99243 • Office Visits | $41 | $63 | $91 |
| Consultation office high complexity CPT 99245 • Office Visits | $41 | $166 | $248 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $41 | $352 | $562 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $41 | $53 | $61 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $906 | $999 | $1,091 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $41 | $183 | $296 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $41 | $304 | $829 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $441 | $441 | $441 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $41 | $190 | $286 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $41 | $601 | $1,004 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $41 | $209 | $540 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $41 | $69 | $121 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $41 | $648 | $1,378 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $41 | $377 | $601 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $41 | $733 | $1,034 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $41 | $328 | $525 |
| Excision chalazion single CPT 67800 • Ophthalmology | $41 | $58 | $91 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $41 | $413 | $648 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $41 | $55 | $84 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $20 | $57 | $75 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $60 | $112 | $139 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $21 | $51 | $80 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $32 | $76 | $115 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $65 | $95 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $8 | $32 | $45 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $51 | $87 |
| Fundus photography CPT 92250 • Ophthalmology | $10 | $37 | $59 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $39 | $41 | $43 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $33 | $38 | $41 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $41 | $46 | $58 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,557 | $1,574 | $1,608 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $41 | $900 | $1,435 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,636 | $1,699 | $1,788 |