| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $137 | $626 | $1,115 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $83 | $316 | $550 |
| Excision chalazion single CPT 67800 • Ophthalmology | $34 | $34 | $34 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $113 | $385 | $656 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $21 | $82 | $142 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $30 | $52 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $10 | $10 | $10 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $4 | $22 | $40 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $12 | $12 |
| Visual field examination CPT 92083 • Ophthalmology | $29 | $29 | $29 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $13 | $22 | $31 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $33 | $46 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $24 | $28 | $33 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $29 | $29 | $29 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $7 | $19 | $30 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,235 | $1,563 | $1,892 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $821 | $1,224 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,898 | $1,898 | $1,898 |
| Total shoulder replacement CPT 23472 • Orthopedics | $30 | $30 | $30 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $168 | $168 | $168 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $337 | $393 | $449 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $211 | $211 | $211 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $582 | $582 | $582 |
| Total hip replacement CPT 27130 • Orthopedics | $34 | $762 | $1,491 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,729 | $1,735 | $1,741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $864 | $1,043 | $1,222 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $634 | $634 | $634 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $127 | $127 | $127 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $116 | $636 | $1,156 |
| Total knee replacement CPT 27447 • Orthopedics | $1,399 | $1,498 | $1,598 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $297 | $438 | $579 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $206 | $206 | $206 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $112 | $424 | $736 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $36 | $36 | $36 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $222 | $672 | $1,123 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $291 | $496 | $701 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $653 | $653 | $654 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $34 | $34 | $34 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $153 | $153 | $153 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $150 | $567 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $574 | $1,118 |
| Carpal tunnel release CPT 64721 • Orthopedics | $219 | $322 | $424 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $170 | $170 | $170 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $56 | $56 | $56 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $45 | $45 | $45 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $55 | $167 | $278 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $425 | $562 | $699 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $11 | $11 | $11 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $27 | $40 | $54 |