| Office visit new patient moderate complexity CPT 99204 • Office Visits | $162 | $168 | $175 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $144 | $176 | $209 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $30 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $59 | $59 | $59 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $95 | $95 | $95 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $101 | $118 | $135 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $191 | $191 | $191 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $170 | $170 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $146 | $146 | $146 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $215 | $215 | $215 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $77 | $77 | $77 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $110 | $110 | $110 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $78 | $78 | $78 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $114 | $114 | $114 |
| Consultation office low complexity CPT 99243 • Office Visits | $118 | $118 | $118 |
| Consultation office high complexity CPT 99245 • Office Visits | $213 | $218 | $223 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $601 | $601 | $601 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $37 | $37 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,047 | $1,047 | $1,047 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $471 | $476 | $482 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $521 | $521 | $521 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,141 | $1,141 | $1,141 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $495 | $495 | $495 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $213 | $270 | $326 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $750 | $750 | $750 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $83 | $83 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $93 | $93 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $47 | $47 | $47 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $122 | $122 | $122 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $14 | $14 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $29 | $29 |
| Fundus photography CPT 92250 • Ophthalmology | $20 | $20 | $20 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $35 | $35 | $35 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $57 | $57 | $57 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,545 | $1,545 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,608 | $1,704 | $1,800 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Total hip replacement CPT 27130 • Orthopedics | $1,254 | $1,254 | $1,254 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,631 | $1,631 | $1,631 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,166 | $1,166 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,199 | $1,199 | $1,199 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $30 | $30 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,127 | $1,127 | $1,127 |
| Total knee replacement CPT 27447 • Orthopedics | $1,138 | $1,195 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $512 | $540 | $568 |