| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $283 | $343 | $404 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $355 | $533 | $710 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $91 | $151 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $42 | $278 | $515 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $21 | $32 | $42 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $33 | $61 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $113 | $113 | $113 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $10 | $24 | $39 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $6 | $6 | $6 |
| Visual field examination CPT 92083 • Ophthalmology | $24 | $28 | $32 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $19 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $8 | $43 | $79 |
| Fundus photography CPT 92250 • Ophthalmology | $20 | $31 | $42 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $42 | $45 | $47 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $6 | $24 | $42 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $30 | $37 | $44 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,850 | $1,850 | $1,851 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,267 | $1,478 | $1,689 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $198 | $198 | $198 |
| Total shoulder replacement CPT 23472 • Orthopedics | $42 | $96 | $150 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $252 | $252 | $252 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $437 | $437 | $437 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $42 | $54 | $67 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $158 | $158 | $158 |
| Total hip replacement CPT 27130 • Orthopedics | $1,401 | $1,401 | $1,401 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $346 | $346 | $346 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $42 | $639 | $1,236 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $42 | $116 | $191 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $891 | $891 | $891 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $838 | $1,018 | $1,197 |
| Total knee replacement CPT 27447 • Orthopedics | $1,051 | $1,225 | $1,400 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $59 | $323 | $588 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $204 | $204 | $204 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $540 | $629 | $719 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $42 | $89 | $137 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $540 | $810 | $1,080 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $116 | $347 | $579 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $391 | $474 | $558 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $507 | $507 | $507 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $102 | $102 | $102 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $178 | $682 | $1,186 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $271 | $812 | $1,353 |
| Carpal tunnel release CPT 64721 • Orthopedics | $379 | $442 | $505 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $13 | $27 | $42 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $25 | $25 | $25 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $36 | $36 | $36 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $58 | $170 | $282 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $42 | $139 | $237 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $42 | $42 | $42 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $39 | $46 | $53 |