| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $225 | $326 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $30 | $246 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $67 | $123 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $524 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $71 | $118 | $142 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $23 | $68 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $101 | $145 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $18 | $87 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $35 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $22 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $7 | $24 | $29 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $26 | $35 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $18 | $33 | $51 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $27 | $37 | $53 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $30 | $52 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,241 | $1,551 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $838 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $360 | $1,320 | $1,800 |
| Total shoulder replacement CPT 23472 • Orthopedics | $30 | $491 | $1,414 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,182 | $1,445 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $378 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $30 | $131 | $332 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $333 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $666 | $1,254 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $905 | $1,631 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $649 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $450 | $1,199 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $906 | $1,198 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $579 | $1,127 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $791 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $114 | $454 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $127 | $309 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $276 | $500 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $89 | $169 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $661 | $1,045 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $386 | $550 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $365 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $191 | $674 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $509 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $489 | $948 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $679 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $245 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $94 | $158 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $52 | $189 | $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 | $1,344 | $2,287 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $11 | $38 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $33 | $44 | $48 |