| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $148 | $217 | $286 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $733 | $944 | $1,155 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $534 | $649 | $763 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $248 | $248 | $248 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $536 | $536 | $536 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $42 | $282 | $729 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $42 | $42 | $42 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $42 | $407 | $773 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $347 | $481 | $615 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $202 | $303 | $404 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $30 | $370 | $710 |
| Excision chalazion single CPT 67800 • Ophthalmology | $10 | $80 | $151 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $36 | $42 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $14 | $95 | $175 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $23 | $42 | $61 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $47 | $80 | $113 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $5 | $27 | $49 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $37 | $37 | $37 |
| Visual field examination CPT 92083 • Ophthalmology | $28 | $56 | $85 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $39 | $39 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $64 | $84 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $28 | $42 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $4 | $35 | $67 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $36 | $44 | $52 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $42 | $50 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $311 | $1,134 | $1,850 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $42 | $866 | $1,689 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $344 | $1,073 | $1,801 |
| Total shoulder replacement CPT 23472 • Orthopedics | $42 | $162 | $283 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $788 | $788 | $788 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $425 | $437 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $33 | $175 | $449 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $213 | $300 | $387 |
| Total hip replacement CPT 27130 • Orthopedics | $210 | $1,148 | $1,833 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $42 | $639 | $1,236 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $840 | $840 | $840 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $42 | $620 | $1,199 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $846 | $1,021 | $1,197 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $1,087 | $1,831 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $114 | $351 | $588 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $28 | $162 | $426 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $605 | $662 | $719 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $42 | $135 | $237 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $523 | $1,016 | $1,444 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $385 | $573 | $755 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $106 | $530 | $927 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $268 | $507 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $42 | $683 | $1,324 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $190 | $1,120 | $1,986 |