| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $63 | $202 | $340 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $47 | $47 | $47 |
| Excision chalazion single CPT 67800 • Ophthalmology | $53 | $53 | $53 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $459 | $638 | $818 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $105 | $105 | $105 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $43 | $79 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $70 | $108 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $24 | $56 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $59 | $92 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $25 | $40 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $24 | $30 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $9 | $32 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $34 | $35 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $5 | $5 | $5 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $17 | $33 | $49 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $4 | $38 | $71 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $671 | $1,077 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,074 | $1,074 | $1,074 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,639 | $1,639 | $1,639 |
| Total shoulder replacement CPT 23472 • Orthopedics | $262 | $262 | $262 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $292 | $292 | $292 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $268 | $326 | $383 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $65 | $65 | $65 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $264 | $264 | $264 |
| Total hip replacement CPT 27130 • Orthopedics | $817 | $817 | $817 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $757 | $757 | $757 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $163 | $163 | $163 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $168 | $168 | $168 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $167 | $642 | $1,116 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $732 | $732 | $732 |
| Total knee replacement CPT 27447 • Orthopedics | $233 | $233 | $233 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $381 | $381 | $381 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $41 | $41 | $41 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $158 | $158 | $158 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $116 | $135 | $154 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $146 | $146 | $146 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $517 | $517 | $517 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $75 | $75 | $75 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $474 | $553 | $632 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $178 | $178 | $178 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $162 | $598 | $1,035 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $976 | $976 | $976 |
| Carpal tunnel release CPT 64721 • Orthopedics | $39 | $39 | $39 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $111 | $134 | $157 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $19 | $56 | $93 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $10 | $10 | $10 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $33 | $128 | $222 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $382 | $382 | $382 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $13 | $13 | $13 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $22 | $32 | $43 |