| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $51 | $152 | $254 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $40 | $242 | $444 |
| Excision chalazion single CPT 67800 • Ophthalmology | $10 | $10 | $10 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $328 | $328 | $328 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $55 | $55 | $55 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $31 | $47 | $62 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $76 | $76 | $76 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $4 | $4 | $4 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $9 | $35 | $60 |
| Visual field examination CPT 92083 • Ophthalmology | $10 | $18 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $15 | $19 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $6 | $32 | $58 |
| Fundus photography CPT 92250 • Ophthalmology | $40 | $40 | $40 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $16 | $16 | $16 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $26 | $45 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $4 | $4 | $4 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,602 | $1,602 | $1,603 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,340 | $1,340 | $1,340 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $168 | $168 | $168 |
| Total shoulder replacement CPT 23472 • Orthopedics | $620 | $620 | $620 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,457 | $1,457 | $1,457 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $264 | $307 | $351 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $217 | $217 | $217 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $35 | $133 | $231 |
| Total hip replacement CPT 27130 • Orthopedics | $40 | $617 | $1,193 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,396 | $1,396 | $1,396 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $736 | $858 | $981 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $40 | $525 | $1,009 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,023 | $1,023 | $1,023 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $914 | $914 | $914 |
| Total knee replacement CPT 27447 • Orthopedics | $255 | $766 | $1,276 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $40 | $249 | $458 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $40 | $40 | $40 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $40 | $293 | $545 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $406 | $406 | $406 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $40 | $463 | $886 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $390 | $474 | $557 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $78 | $299 | $520 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $40 | $40 | $40 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $40 | $40 | $40 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $40 | $422 | $803 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $688 | $803 | $917 |
| Carpal tunnel release CPT 64721 • Orthopedics | $233 | $283 | $333 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $28 | $28 | $28 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $211 | $211 | $211 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $67 | $67 | $67 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $21 | $113 | $206 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $233 | $233 | $233 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $6 | $6 | $6 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $40 | $40 |