| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $73 | $238 | $404 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $71 | $391 | $710 |
| Excision chalazion single CPT 67800 • Ophthalmology | $92 | $92 | $92 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $42 | $42 | $42 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $176 | $176 | $176 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $18 | $39 | $61 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $74 | $94 | $113 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $6 | $6 | $6 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $6 | $6 | $6 |
| Visual field examination CPT 92083 • Ophthalmology | $32 | $44 | $56 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $14 | $15 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $16 | $47 | $79 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $28 | $42 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $7 | $25 | $42 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $36 | $43 | $50 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $42 | $51 | $61 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,850 | $1,850 | $1,851 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,267 | $1,478 | $1,689 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $397 | $397 | $397 |
| Total shoulder replacement CPT 23472 • Orthopedics | $42 | $547 | $1,052 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,260 | $1,260 | $1,260 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $306 | $306 | $306 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $42 | $53 | $63 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $158 | $158 | $158 |
| Total hip replacement CPT 27130 • Orthopedics | $1,401 | $1,401 | $1,401 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,731 | $1,731 | $1,731 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $42 | $639 | $1,236 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $42 | $498 | $955 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $191 | $191 | $191 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $838 | $1,018 | $1,197 |
| Total knee replacement CPT 27447 • Orthopedics | $210 | $805 | $1,400 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $59 | $323 | $588 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $291 | $291 | $291 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $52 | $385 | $719 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $42 | $67 | $91 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $811 | $945 | $1,080 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $290 | $434 | $579 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $558 | $558 | $558 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $72 | $72 | $72 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $713 | $713 | $713 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $890 | $1,038 | $1,186 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $42 | $698 | $1,353 |
| Carpal tunnel release CPT 64721 • Orthopedics | $50 | $278 | $505 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $42 | $82 | $121 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $216 | $216 | $216 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $27 | $27 | $27 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $42 | $162 | $282 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $42 | $790 | $1,537 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $42 | $47 | $52 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $47 | $53 |