| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $33 | $574 | $1,115 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $323 | $437 | $550 |
| Excision chalazion single CPT 67800 • Ophthalmology | $12 | $12 | $12 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $30 | $30 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $107 | $107 | $107 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $52 | $68 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $93 | $93 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $25 | $25 | $25 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $75 | $75 | $75 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $28 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $27 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $10 | $35 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $21 | $21 | $21 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $8 | $8 | $8 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $8 | $8 | $8 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $44 | $44 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,525 | $1,892 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $773 | $1,200 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,351 | $1,351 | $1,351 |
| Total shoulder replacement CPT 23472 • Orthopedics | $707 | $707 | $707 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $236 | $236 | $236 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $289 | $289 | $289 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $50 | $50 | $50 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $285 | $285 | $285 |
| Total hip replacement CPT 27130 • Orthopedics | $251 | $871 | $1,491 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $245 | $993 | $1,741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $583 | $903 | $1,222 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,200 | $1,200 | $1,200 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $899 | $899 | $899 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $226 | $691 | $1,156 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $814 | $1,598 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $85 | $332 | $579 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $155 | $155 | $155 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $649 | $692 | $736 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $169 | $169 | $169 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $209 | $666 | $1,123 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $491 | $596 | $701 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $530 | $591 | $653 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $674 | $674 | $674 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $30 | $30 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $474 | $729 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $161 | $640 | $1,118 |
| Carpal tunnel release CPT 64721 • Orthopedics | $424 | $429 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $60 | $60 | $60 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $52 | $155 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $40 | $40 | $40 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $73 | $175 | $278 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $229 | $229 | $229 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $37 | $37 | $37 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $25 | $40 | $54 |