| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $30 | $145 | $368 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $94 | $157 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $362 | $362 | $362 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $184 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $389 | $747 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $355 | $373 | $391 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $55 | $113 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $799 | $799 | $799 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $192 | $515 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $148 | $357 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $30 | $246 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $19 | $19 | $19 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $77 | $77 | $77 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $30 | $57 | $85 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $5 | $5 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $80 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $25 | $56 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $93 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $45 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $25 | $30 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $10 | $47 | $84 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $36 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $5 | $41 | $67 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $27 | $58 | $89 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $30 | $43 | $52 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $311 | $1,068 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $788 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $344 | $803 | $1,261 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,414 | $1,414 | $1,414 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $315 | $315 | $315 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $309 | $309 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $223 | $336 | $449 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $199 | $293 | $387 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $814 | $2,383 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $423 | $816 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $598 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $240 | $240 | $240 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $71 | $113 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $630 | $1,831 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $72 | $114 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $162 | $426 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $80 | $130 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $127 | $182 | $237 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $501 | $1,444 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $353 | $755 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $354 | $927 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $337 | $337 | $337 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $143 | $733 | $1,324 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $688 | $1,324 |