| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $28 | $28 | $28 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $724 | $724 | $724 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $151 | $151 | $151 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $670 | $670 | $670 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $308 | $308 | $308 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $184 | $184 | $184 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $459 | $459 | $459 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $335 | $654 | $814 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $62 | $123 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $733 | $733 | $733 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $317 | $317 | $317 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $209 | $409 | $510 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $366 | $366 | $366 |
| Excision chalazion single CPT 67800 • Ophthalmology | $63 | $63 | $63 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $479 | $479 | $479 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $72 | $115 | $159 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $51 | $65 | $80 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $92 | $115 | $139 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $47 | $61 | $83 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $71 | $88 | $117 |
| Visual field examination CPT 92083 • Ophthalmology | $33 | $36 | $39 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $16 | $25 | $37 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $38 | $42 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $13 | $37 | $68 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $31 | $31 | $31 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $32 | $32 | $32 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $29 | $29 | $29 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,069 | $1,069 | $1,069 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $996 | $996 | $996 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,162 | $1,162 | $1,162 |
| Total shoulder replacement CPT 23472 • Orthopedics | $909 | $909 | $909 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,014 | $1,014 | $1,014 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $259 | $259 | $259 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $206 | $206 | $206 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $338 | $338 | $338 |
| Total hip replacement CPT 27130 • Orthopedics | $849 | $849 | $849 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,049 | $1,049 | $1,049 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $748 | $748 | $748 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $770 | $770 | $770 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $769 | $769 | $769 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $725 | $725 | $725 |
| Total knee replacement CPT 27447 • Orthopedics | $848 | $848 | $848 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $359 | $359 | $359 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $195 | $195 | $195 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $567 | $567 | $567 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $109 | $109 | $109 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $669 | $669 | $669 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $351 | $351 | $351 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $338 | $338 | $338 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $433 | $433 | $433 |