| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $45 | $167 | $288 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $45 | $47 | $49 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $45 | $178 | $311 |
| Excision chalazion single CPT 67800 • Ophthalmology | $45 | $69 | $93 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $540 | $540 | $540 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $22 | $22 | $22 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $22 | $46 | $70 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $73 | $73 | $73 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $10 | $31 | $53 |
| Visual field examination CPT 92083 • Ophthalmology | $18 | $24 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $28 | $34 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $25 | $35 | $45 |
| Fundus photography CPT 92250 • Ophthalmology | $31 | $31 | $31 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $32 | $38 | $45 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $45 | $45 | $46 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $45 | $45 | $45 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,414 | $1,669 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $45 | $387 | $728 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $177 | $177 | $177 |
| Total shoulder replacement CPT 23472 • Orthopedics | $707 | $707 | $707 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,182 | $1,182 | $1,182 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $283 | $283 | $283 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $66 | $66 | $66 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $521 | $521 | $521 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $38 | $45 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $45 | $430 | $816 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $45 | $398 | $752 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $774 | $940 | $1,105 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $156 | $156 | $156 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $45 | $79 | $113 |
| Total knee replacement CPT 27447 • Orthopedics | $45 | $458 | $871 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $45 | $48 | $51 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $216 | $239 | $262 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $45 | $72 | $100 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $127 | $127 | $127 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $45 | $282 | $518 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $45 | $215 | $385 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $45 | $184 | $323 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $125 | $125 | $125 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $174 | $174 | $174 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $45 | $331 | $618 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $45 | $521 | $998 |
| Carpal tunnel release CPT 64721 • Orthopedics | $45 | $120 | $195 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $74 | $74 | $74 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $95 | $98 | $101 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $137 | $137 | $137 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $44 | $133 | $222 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $39 | $39 | $39 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $37 | $53 | $68 |