| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $974 | $1,044 | $1,115 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $83 | $316 | $550 |
| Excision chalazion single CPT 67800 • Ophthalmology | $59 | $59 | $59 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $34 | $34 | $34 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $70 | $70 | $70 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $32 | $42 | $52 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $67 | $67 | $67 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $34 | $34 | $34 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $52 | $52 | $53 |
| Visual field examination CPT 92083 • Ophthalmology | $39 | $39 | $39 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $22 | $28 | $35 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $6 | $33 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $34 | $54 | $75 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $41 | $42 | $42 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $16 | $16 | $16 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,419 | $1,656 | $1,892 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,140 | $1,383 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $300 | $300 | $300 |
| Total shoulder replacement CPT 23472 • Orthopedics | $233 | $233 | $233 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $354 | $354 | $354 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $449 | $449 | $449 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $177 | $177 | $177 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $58 | $58 | $58 |
| Total hip replacement CPT 27130 • Orthopedics | $34 | $762 | $1,491 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $174 | $958 | $1,741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $917 | $1,070 | $1,222 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $943 | $943 | $943 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $131 | $131 | $131 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $116 | $636 | $1,156 |
| Total knee replacement CPT 27447 • Orthopedics | $1,119 | $1,358 | $1,598 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $435 | $507 | $579 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $275 | $275 | $275 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $401 | $568 | $736 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $344 | $344 | $344 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $112 | $618 | $1,123 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $491 | $596 | $701 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $34 | $343 | $653 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $354 | $354 | $354 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $512 | $512 | $512 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $148 | $566 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $839 | $979 | $1,118 |
| Carpal tunnel release CPT 64721 • Orthopedics | $42 | $233 | $424 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $70 | $128 | $186 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $60 | $60 | $60 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $97 | $97 | $97 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $56 | $167 | $278 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $33 | $37 | $41 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $7 | $40 | $73 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $54 | $54 | $54 |