| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $499 | $748 | $997 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $450 | $525 | $600 |
| Excision chalazion single CPT 67800 • Ophthalmology | $33 | $33 | $33 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $87 | $332 | $577 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $15 | $15 | $15 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $44 | $80 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $15 | $55 | $95 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $8 | $46 | $84 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $61 | $61 |
| Visual field examination CPT 92083 • Ophthalmology | $33 | $33 | $33 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $31 | $44 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $62 | $77 | $92 |
| Fundus photography CPT 92250 • Ophthalmology | $23 | $40 | $57 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $6 | $25 | $44 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $9 | $28 | $46 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $33 | $33 | $33 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,542 | $1,542 | $1,543 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $720 | $1,079 | $1,439 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $167 | $167 | $167 |
| Total shoulder replacement CPT 23472 • Orthopedics | $666 | $666 | $666 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $149 | $149 | $149 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $282 | $282 | $282 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $313 | $313 | $313 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $205 | $205 | $205 |
| Total hip replacement CPT 27130 • Orthopedics | $186 | $712 | $1,239 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $33 | $781 | $1,530 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $822 | $959 | $1,096 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $33 | $33 | $33 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $790 | $790 | $790 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $743 | $901 | $1,060 |
| Total knee replacement CPT 27447 • Orthopedics | $124 | $681 | $1,238 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $402 | $468 | $535 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $210 | $210 | $210 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $97 | $392 | $686 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $33 | $33 | $33 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $486 | $729 | $972 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $261 | $391 | $521 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $251 | $377 | $502 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $97 | $97 | $97 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $90 | $90 | $90 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $697 | $846 | $995 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $848 | $989 | $1,130 |
| Carpal tunnel release CPT 64721 • Orthopedics | $91 | $271 | $452 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $31 | $31 | $31 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $117 | $117 | $117 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $17 | $17 | $17 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $106 | $189 | $271 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $147 | $147 | $147 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $7 | $27 | $47 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $35 | $42 | $49 |