| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $487 | $801 | $1,115 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $413 | $482 | $550 |
| Excision chalazion single CPT 67800 • Ophthalmology | $73 | $73 | $73 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $459 | $558 | $656 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $33 | $44 | $55 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $28 | $52 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $10 | $10 | $10 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $3 | $3 | $3 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $26 | $26 | $26 |
| Visual field examination CPT 92083 • Ophthalmology | $18 | $24 | $29 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $22 | $28 | $35 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $34 | $47 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $23 | $28 | $34 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $34 | $34 | $34 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $30 | $30 | $30 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $52 | $69 | $79 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,892 | $1,892 | $1,892 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,221 | $1,424 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $300 | $300 | $300 |
| Total shoulder replacement CPT 23472 • Orthopedics | $311 | $311 | $311 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,237 | $1,237 | $1,237 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $314 | $314 | $314 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $281 | $281 | $281 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $45 | $45 | $45 |
| Total hip replacement CPT 27130 • Orthopedics | $34 | $762 | $1,491 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $34 | $887 | $1,741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $122 | $672 | $1,222 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $251 | $251 | $251 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $34 | $34 | $34 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $809 | $983 | $1,156 |
| Total knee replacement CPT 27447 • Orthopedics | $34 | $816 | $1,598 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $435 | $507 | $579 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $153 | $153 | $153 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $147 | $442 | $736 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $344 | $516 | $688 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $562 | $842 | $1,123 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $701 | $701 | $701 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $490 | $572 | $653 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $142 | $142 | $142 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $205 | $205 | $205 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $984 | $984 | $985 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $839 | $979 | $1,118 |
| Carpal tunnel release CPT 64721 • Orthopedics | $297 | $360 | $424 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $71 | $128 | $185 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $120 | $120 | $121 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $18 | $18 | $18 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $11 | $145 | $278 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $309 | $360 | $411 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $11 | $11 | $11 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $47 | $54 |