| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $35 | $49 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $30 | $296 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $19 | $26 | $30 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $162 | $425 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $11 | $109 | $142 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $64 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $145 | $145 | $145 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $122 | $122 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $47 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $24 | $35 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $37 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $26 | $35 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $18 | $27 | $30 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $5 | $24 | $30 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $22 | $27 | $30 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,530 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $312 | $1,159 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $180 | $1,260 | $1,800 |
| Total shoulder replacement CPT 23472 • Orthopedics | $30 | $30 | $30 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $788 | $1,313 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $30 | $30 | $30 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $174 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $336 | $1,255 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $227 | $816 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $360 | $1,199 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $180 | $859 | $1,198 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $220 | $789 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $54 | $125 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $299 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $92 | $216 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $116 | $375 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $95 | $169 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $91 | $275 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $115 | $371 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $54 | $101 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $46 | $96 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $260 | $949 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $211 | $753 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $77 | $217 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $30 | $30 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $104 | $187 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $16 | $97 | $137 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $38 | $200 | $254 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $155 | $406 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $34 | $41 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $33 | $44 | $48 |