| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $40 | $147 | $254 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $222 | $333 | $444 |
| Excision chalazion single CPT 67800 • Ophthalmology | $95 | $95 | $96 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $44 | $44 | $44 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $55 | $55 | $55 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $6 | $32 | $59 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $16 | $16 | $16 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $5 | $5 | $5 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $5 | $29 | $53 |
| Visual field examination CPT 92083 • Ophthalmology | $9 | $26 | $43 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $23 | $28 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $6 | $21 | $37 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $20 | $27 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $29 | $29 | $29 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $3 | $22 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $8 | $24 | $40 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,118 | $1,304 | $1,490 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $960 | $1,165 | $1,371 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,127 | $1,127 | $1,127 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,232 | $1,232 | $1,232 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $963 | $963 | $963 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $347 | $347 | $347 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $188 | $188 | $188 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $40 | $42 | $45 |
| Total hip replacement CPT 27130 • Orthopedics | $230 | $689 | $1,149 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $40 | $730 | $1,419 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $202 | $606 | $1,010 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $729 | $729 | $729 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $781 | $781 | $781 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $147 | $564 | $980 |
| Total knee replacement CPT 27447 • Orthopedics | $230 | $688 | $1,147 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $484 | $484 | $484 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $47 | $47 | $47 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $213 | $477 | $742 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $113 | $113 | $113 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $133 | $508 | $883 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $330 | $401 | $471 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $45 | $249 | $453 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $588 | $588 | $588 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $166 | $166 | $166 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $40 | $439 | $838 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $667 | $810 | $953 |
| Carpal tunnel release CPT 64721 • Orthopedics | $53 | $205 | $356 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $69 | $69 | $69 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $9 | $9 | $9 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $11 | $11 | $11 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $39 | $117 | $195 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $786 | $786 | $786 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $48 | $48 | $48 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $29 | $34 | $39 |