| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $88 | $146 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $92 | $277 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $25 | $25 | $25 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $116 | $116 | $116 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $30 | $86 | $143 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $62 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $73 | $73 | $73 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $5 | $27 | $49 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $75 | $75 | $75 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $43 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $24 | $32 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $33 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $21 | $35 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $26 | $26 | $26 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $8 | $8 | $8 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $32 | $32 | $32 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,406 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $595 | $1,159 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $180 | $180 | $180 |
| Total shoulder replacement CPT 23472 • Orthopedics | $283 | $283 | $283 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,103 | $1,103 | $1,103 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $166 | $166 | $166 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $58 | $58 | $58 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $642 | $1,255 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $423 | $816 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $598 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $240 | $240 | $240 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $599 | $899 | $1,198 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $438 | $846 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $454 | $877 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $228 | $426 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $284 | $284 | $284 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $265 | $501 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $25 | $28 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $120 | $209 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $70 | $110 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $41 | $53 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $82 | $135 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $143 | $550 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $62 | $95 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $418 | $807 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $228 | $425 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $16 | $87 | $158 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $258 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $60 | $60 | $60 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $49 | $151 | $254 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $30 | $30 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $7 | $7 | $7 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $33 | $41 | $48 |