| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $25 | $43 | $73 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $781 | $781 | $781 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $163 | $163 | $163 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $726 | $726 | $726 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $337 | $337 | $337 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $199 | $285 | $371 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $262 | $493 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $360 | $654 | $814 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $75 | $139 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $785 | $785 | $785 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $330 | $330 | $330 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $200 | $388 | $510 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $302 | $302 | $302 |
| Excision chalazion single CPT 67800 • Ophthalmology | $86 | $86 | $86 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $530 | $530 | $530 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $78 | $127 | $177 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $30 | $48 | $66 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $99 | $119 | $139 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $33 | $54 | $83 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $71 | $75 | $84 |
| Visual field examination CPT 92083 • Ophthalmology | $42 | $55 | $67 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $16 | $30 | $37 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $12 | $33 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $11 | $37 | $68 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $36 | $36 | $36 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $37 | $37 | $37 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $44 | $44 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,149 | $1,149 | $1,149 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,066 | $1,066 | $1,066 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,220 | $1,220 | $1,220 |
| Total shoulder replacement CPT 23472 • Orthopedics | $969 | $969 | $969 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,077 | $1,077 | $1,077 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $284 | $284 | $284 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $237 | $237 | $237 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $397 | $397 | $397 |
| Total hip replacement CPT 27130 • Orthopedics | $862 | $862 | $862 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,119 | $1,119 | $1,119 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $803 | $803 | $803 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $825 | $825 | $825 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $824 | $824 | $824 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $771 | $771 | $771 |
| Total knee replacement CPT 27447 • Orthopedics | $860 | $860 | $860 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $394 | $394 | $394 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $219 | $219 | $219 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $591 | $591 | $591 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $114 | $114 | $114 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $719 | $719 | $719 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $382 | $382 | $382 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $368 | $368 | $368 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $466 | $466 | $466 |