| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $141 | $228 | $315 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $319 | $371 | $422 |
| Excision chalazion single CPT 67800 • Ophthalmology | $12 | $12 | $12 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $110 | $110 | $110 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $135 | $136 | $137 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $44 | $62 | $80 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $77 | $141 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $24 | $36 | $47 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $60 | $66 | $72 |
| Visual field examination CPT 92083 • Ophthalmology | $30 | $30 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $28 | $38 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $5 | $24 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $15 | $15 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $50 | $50 | $50 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $5 | $28 | $50 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $6 | $6 | $6 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,038 | $1,258 | $1,478 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $279 | $837 | $1,395 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,110 | $1,344 | $1,578 |
| Total shoulder replacement CPT 23472 • Orthopedics | $654 | $654 | $654 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,019 | $1,237 | $1,455 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $293 | $342 | $392 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $47 | $47 | $47 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $80 | $80 | $80 |
| Total hip replacement CPT 27130 • Orthopedics | $581 | $870 | $1,159 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $226 | $866 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $217 | $648 | $1,080 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $167 | $167 | $167 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $780 | $780 | $780 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $729 | $884 | $1,038 |
| Total knee replacement CPT 27447 • Orthopedics | $174 | $666 | $1,158 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $408 | $469 | $530 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $30 | $30 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $122 | $472 | $823 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $154 | $154 | $154 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $730 | $850 | $971 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $78 | $296 | $514 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $50 | $273 | $496 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $126 | $126 | $126 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $888 | $888 | $888 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $579 | $692 | $804 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $149 | $560 | $971 |
| Carpal tunnel release CPT 64721 • Orthopedics | $210 | $310 | $409 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $23 | $23 | $23 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $76 | $76 | $76 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $124 | $124 | $124 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $120 | $180 | $240 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $39 | $39 | $39 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $69 | $69 | $70 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $32 | $39 | $46 |