| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $63 | $189 | $315 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $213 | $317 | $422 |
| Excision chalazion single CPT 67800 • Ophthalmology | $67 | $81 | $94 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $733 | $733 | $733 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $67 | $67 | $67 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $44 | $80 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $9 | $9 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $24 | $24 | $24 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $7 | $7 | $7 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $22 | $32 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $22 | $31 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $23 | $33 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $14 | $20 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $5 | $5 | $5 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $8 | $29 | $50 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $31 | $36 | $41 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,112 | $1,295 | $1,478 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $978 | $1,186 | $1,395 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $238 | $238 | $238 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,309 | $1,309 | $1,309 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,091 | $1,091 | $1,091 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $273 | $333 | $392 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $49 | $49 | $49 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $27 | $27 | $27 |
| Total hip replacement CPT 27130 • Orthopedics | $1,159 | $1,161 | $1,162 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,131 | $1,319 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $108 | $594 | $1,080 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $167 | $639 | $1,110 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,114 | $1,114 | $1,114 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $521 | $779 | $1,038 |
| Total knee replacement CPT 27447 • Orthopedics | $813 | $985 | $1,158 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $82 | $306 | $530 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $209 | $252 | $295 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $243 | $533 | $823 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $115 | $115 | $115 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $971 | $972 | $973 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $78 | $296 | $514 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $250 | $373 | $496 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $126 | $126 | $126 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $888 | $888 | $888 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $166 | $485 | $804 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $498 | $735 | $971 |
| Carpal tunnel release CPT 64721 • Orthopedics | $210 | $310 | $409 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $77 | $77 | $77 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $99 | $171 | $243 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $25 | $25 | $25 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $24 | $132 | $240 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $196 | $196 | $196 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $29 | $29 | $29 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $24 | $35 | $46 |