| Office visit new patient straightforward CPT 99202 • Office Visits | $61 | $67 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $50 | $71 | $91 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $50 | $90 | $129 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $50 | $141 | $207 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $15 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $36 | $43 | $50 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $49 | $58 | $73 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $50 | $73 | $92 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $50 | $102 | $142 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $78 | $105 | $131 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $110 | $125 | $141 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $153 | $175 | $208 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $36 | $56 | $87 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $60 | $74 | $87 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $78 | $92 | $106 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $68 | $77 | $87 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $103 | $108 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $120 | $125 |
| Consultation office high complexity CPT 99245 • Office Visits | $225 | $226 | $226 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $955 | $1,048 | $1,140 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $955 | $955 | $955 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $955 | $1,818 | $2,434 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $152 | $553 | $955 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,180 | $1,296 | $1,411 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $955 | $1,180 | $1,411 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $210 | $582 | $955 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $955 | $1,183 | $1,411 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $955 | $1,183 | $1,411 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $54 | $359 | $955 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $955 | $1,694 | $2,434 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $316 | $636 | $955 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $200 | $578 | $955 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $955 | $1,134 | $1,254 |
| Excision chalazion single CPT 67800 • Ophthalmology | $64 | $369 | $955 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $955 | $1,048 | $1,192 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $106 | $530 | $955 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $81 | $81 | $81 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $142 | $142 | $142 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $84 | $84 | $84 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $120 | $120 | $120 |
| Visual field examination CPT 92083 • Ophthalmology | $58 | $58 | $58 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $38 | $38 | $38 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $47 | $47 | $47 |
| Fundus photography CPT 92250 • Ophthalmology | $35 | $35 | $35 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $27 | $338 | $955 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $33 | $494 | $955 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $35 | $343 | $955 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $955 | $5,747 | $10,539 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $955 | $8,779 | $16,312 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $955 | $955 | $955 |