| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $61 | $189 | $317 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $319 | $371 | $424 |
| Excision chalazion single CPT 67800 • Ophthalmology | $42 | $67 | $91 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $42 | $427 | $812 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $110 | $110 | $110 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $11 | $41 | $71 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $12 | $12 | $12 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $6 | $6 | $6 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $11 | $37 | $64 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $39 | $52 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $12 | $16 | $21 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $8 | $23 | $39 |
| Fundus photography CPT 92250 • Ophthalmology | $17 | $24 | $31 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $33 | $41 | $49 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $35 | $43 | $51 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $41 | $43 | $45 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,533 | $1,546 | $1,559 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $146 | $793 | $1,440 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $817 | $817 | $817 |
| Total shoulder replacement CPT 23472 • Orthopedics | $135 | $135 | $135 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $151 | $151 | $151 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $280 | $338 | $396 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $42 | $175 | $308 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $192 | $192 | $192 |
| Total hip replacement CPT 27130 • Orthopedics | $42 | $614 | $1,186 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,540 | $1,549 | $1,558 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,103 | $1,109 | $1,116 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $172 | $172 | $172 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,147 | $1,147 | $1,147 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $743 | $902 | $1,061 |
| Total knee replacement CPT 27447 • Orthopedics | $599 | $891 | $1,184 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $378 | $459 | $540 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $60 | $60 | $60 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $242 | $535 | $827 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $16 | $16 | $16 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $991 | $996 | $1,002 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $106 | $315 | $524 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $379 | $442 | $505 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $128 | $128 | $128 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $181 | $181 | $181 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $581 | $706 | $830 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $944 | $974 | $1,003 |
| Carpal tunnel release CPT 64721 • Orthopedics | $408 | $412 | $415 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $39 | $39 | $39 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $94 | $94 | $94 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $12 | $71 | $129 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $46 | $144 | $241 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $36 | $212 | $388 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $4 | $4 | $4 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $24 | $35 | $47 |