| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $27 | $146 | $266 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $70 | $267 | $465 |
| Excision chalazion single CPT 67800 • Ophthalmology | $16 | $31 | $45 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $92 | $92 | $92 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $14 | $29 | $45 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $17 | $40 | $62 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $11 | $39 | $68 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $10 | $37 | $64 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $6 | $6 | $6 |
| Visual field examination CPT 92083 • Ophthalmology | $23 | $23 | $23 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $15 | $18 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $39 | $42 | $45 |
| Fundus photography CPT 92250 • Ophthalmology | $6 | $9 | $13 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $31 | $31 | $31 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $45 | $45 | $45 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $4 | $4 | $4 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,213 | $1,415 | $1,617 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,473 | $1,473 | $1,474 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $868 | $868 | $868 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,307 | $1,307 | $1,307 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,096 | $1,096 | $1,096 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $276 | $276 | $276 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $45 | $93 | $141 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $203 | $203 | $203 |
| Total hip replacement CPT 27130 • Orthopedics | $1,219 | $1,219 | $1,219 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $301 | $904 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $751 | $912 | $1,073 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $166 | $166 | $166 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $774 | $774 | $774 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $781 | $910 | $1,040 |
| Total knee replacement CPT 27447 • Orthopedics | $1,218 | $1,218 | $1,218 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $383 | $447 | $511 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $55 | $55 | $55 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $781 | $781 | $782 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $160 | $160 | $160 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $654 | $794 | $934 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $350 | $424 | $499 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $480 | $480 | $481 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $63 | $63 | $63 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $176 | $176 | $176 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $904 | $904 | $905 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $103 | $566 | $1,029 |
| Carpal tunnel release CPT 64721 • Orthopedics | $38 | $208 | $378 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $45 | $45 | $45 |
| 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 | $8 | $8 | $8 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $155 | $180 | $206 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $110 | $110 | $110 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $34 | $36 | $39 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $30 | $35 | $40 |