| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $27 | $36 | $45 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $45 | $185 | $326 |
| Excision chalazion single CPT 67800 • Ophthalmology | $60 | $70 | $80 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $229 | $229 | $229 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $68 | $92 | $116 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $9 | $36 | $62 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $69 | $69 | $69 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $37 | $37 | $37 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $6 | $30 | $55 |
| Visual field examination CPT 92083 • Ophthalmology | $19 | $19 | $19 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $15 | $18 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $6 | $25 | $45 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $30 | $45 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $8 | $8 | $8 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $6 | $25 | $43 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $6 | $6 | $6 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,213 | $1,213 | $1,213 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $45 | $759 | $1,474 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,737 | $1,737 | $1,737 |
| Total shoulder replacement CPT 23472 • Orthopedics | $196 | $196 | $196 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,022 | $1,022 | $1,022 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $258 | $313 | $368 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $187 | $187 | $187 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $270 | $270 | $270 |
| Total hip replacement CPT 27130 • Orthopedics | $45 | $480 | $914 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $45 | $399 | $753 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $45 | $76 | $107 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $45 | $45 | $45 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $166 | $166 | $166 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $45 | $283 | $520 |
| Total knee replacement CPT 27447 • Orthopedics | $45 | $144 | $244 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $45 | $278 | $511 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $41 | $41 | $41 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $45 | $218 | $391 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $160 | $160 | $160 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $45 | $116 | $187 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $45 | $60 | $75 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $45 | $263 | $481 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $45 | $45 | $45 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $176 | $176 | $176 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $45 | $362 | $678 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $45 | $537 | $1,030 |
| Carpal tunnel release CPT 64721 • Orthopedics | $45 | $164 | $282 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $20 | $20 | $20 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $10 | $10 | $10 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $58 | $58 | $58 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $155 | $155 | $155 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $71 | $214 | $356 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $7 | $7 | $7 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $31 | $31 | $31 |