| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $48 | $252 | $456 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $56 | $427 | $798 |
| Excision chalazion single CPT 67800 • Ophthalmology | $19 | $19 | $19 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $412 | $412 | $412 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $16 | $87 | $157 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $60 | $84 | $108 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $19 | $104 | $190 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $8 | $8 | $8 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $12 | $12 |
| Visual field examination CPT 92083 • Ophthalmology | $35 | $35 | $35 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $13 | $23 | $33 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $8 | $38 | $68 |
| Fundus photography CPT 92250 • Ophthalmology | $16 | $16 | $16 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $4 | $25 | $46 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $33 | $33 | $33 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $40 | $40 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,379 | $1,674 | $1,969 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $40 | $946 | $1,851 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $430 | $430 | $430 |
| Total shoulder replacement CPT 23472 • Orthopedics | $172 | $172 | $172 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $287 | $287 | $287 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $501 | $501 | $502 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $29 | $29 | $29 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $104 | $104 | $104 |
| Total hip replacement CPT 27130 • Orthopedics | $1,142 | $1,332 | $1,522 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $198 | $1,088 | $1,978 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,060 | $1,237 | $1,413 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $40 | $129 | $218 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $163 | $163 | $163 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $957 | $1,162 | $1,367 |
| Total knee replacement CPT 27447 • Orthopedics | $114 | $817 | $1,521 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $358 | $521 | $684 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $196 | $226 | $256 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $123 | $605 | $1,087 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $31 | $31 | $31 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $95 | $681 | $1,268 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $50 | $358 | $667 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $322 | $482 | $643 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $164 | $164 | $164 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $651 | $906 | $1,160 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $662 | $874 | $1,087 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $700 | $966 | $1,232 |
| Carpal tunnel release CPT 64721 • Orthopedics | $61 | $282 | $502 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $30 | $30 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $50 | $50 | $50 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $14 | $14 | $14 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $19 | $161 | $303 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $293 | $387 | $481 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $40 | $40 | $40 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $56 | $56 | $57 |