| Consultation office high complexity CPT 99245 • Office Visits | $89 | $89 | $89 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $295 | $295 | $295 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $23 | $23 | $23 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $481 | $481 | $481 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $125 | $125 | $125 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $491 | $491 | $491 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $257 | $257 | $257 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $186 | $186 | $186 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $447 | $447 | $447 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $321 | $321 | $321 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $71 | $71 | $71 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $673 | $673 | $673 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $280 | $280 | $280 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $498 | $498 | $498 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $250 | $250 | $250 |
| Excision chalazion single CPT 67800 • Ophthalmology | $53 | $53 | $53 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $244 | $244 | $244 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $49 | $49 | $49 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $33 | $33 | $33 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $61 | $61 | $61 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $34 | $34 | $34 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $50 | $50 | $50 |
| Visual field examination CPT 92083 • Ophthalmology | $23 | $23 | $23 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $22 | $22 | $22 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $35 | $35 | $35 |
| Fundus photography CPT 92250 • Ophthalmology | $10 | $10 | $10 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $23 | $23 | $23 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $18 | $18 | $18 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $22 | $22 | $22 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $849 | $849 | $849 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $699 | $699 | $699 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $909 | $909 | $909 |
| Total shoulder replacement CPT 23472 • Orthopedics | $659 | $659 | $659 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $801 | $801 | $801 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $189 | $189 | $189 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $118 | $118 | $118 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $126 | $126 | $126 |
| Total hip replacement CPT 27130 • Orthopedics | $634 | $634 | $634 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $741 | $741 | $741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $522 | $522 | $522 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $537 | $537 | $537 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $545 | $545 | $545 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $486 | $486 | $486 |
| Total knee replacement CPT 27447 • Orthopedics | $678 | $678 | $678 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $246 | $246 | $246 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $129 | $129 | $129 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $234 | $234 | $234 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $290 | $290 | $290 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $472 | $472 | $472 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $298 | $298 | $298 |