| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $12 | $12 | $12 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $605 | $605 | $605 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $105 | $105 | $105 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $844 | $844 | $844 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $261 | $261 | $261 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $77 | $77 | $77 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $382 | $382 | $382 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $279 | $279 | $279 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $608 | $608 | $608 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $161 | $161 | $161 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $155 | $155 | $155 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $148 | $148 | $148 |
| Excision chalazion single CPT 67800 • Ophthalmology | $33 | $33 | $33 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $454 | $454 | $454 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $60 | $60 | $60 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $23 | $23 | $23 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $48 | $48 | $48 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $26 | $26 | $26 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $65 | $65 | $65 |
| Visual field examination CPT 92083 • Ophthalmology | $33 | $33 | $33 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $13 | $13 | $13 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $37 | $37 | $37 |
| Fundus photography CPT 92250 • Ophthalmology | $29 | $29 | $29 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $18 | $18 | $18 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $12 | $12 | $12 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $51 | $51 | $51 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $125 | $125 | $125 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $132 | $132 | $132 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $946 | $946 | $946 |
| Total shoulder replacement CPT 23472 • Orthopedics | $751 | $751 | $751 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $835 | $835 | $835 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $220 | $220 | $220 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $111 | $111 | $111 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $233 | $233 | $233 |
| Total hip replacement CPT 27130 • Orthopedics | $668 | $668 | $668 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $546 | $546 | $546 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $934 | $934 | $934 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $90 | $90 | $90 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $89 | $89 | $89 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $84 | $84 | $84 |
| Total knee replacement CPT 27447 • Orthopedics | $107 | $107 | $107 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $458 | $458 | $458 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $155 | $155 | $155 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $43 | $43 | $43 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $88 | $88 | $88 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $89 | $89 | $89 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $296 | $296 | $296 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $285 | $285 | $285 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $361 | $361 | $361 |