| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $658 | $828 | $997 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $300 | $450 | $600 |
| Excision chalazion single CPT 67800 • Ophthalmology | $72 | $72 | $72 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $77 | $77 | $77 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $33 | $33 | $33 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $44 | $80 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $10 | $10 | $10 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $51 | $51 | $51 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $12 | $12 |
| Visual field examination CPT 92083 • Ophthalmology | $38 | $52 | $65 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $28 | $36 | $44 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $33 | $62 | $92 |
| Fundus photography CPT 92250 • Ophthalmology | $23 | $28 | $33 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $9 | $26 | $44 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $3 | $18 | $32 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $6 | $24 | $41 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,542 | $1,542 | $1,543 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $216 | $827 | $1,439 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $167 | $167 | $167 |
| Total shoulder replacement CPT 23472 • Orthopedics | $999 | $1,165 | $1,331 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,485 | $1,485 | $1,485 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $402 | $402 | $403 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $59 | $59 | $59 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $205 | $205 | $205 |
| Total hip replacement CPT 27130 • Orthopedics | $929 | $1,084 | $1,239 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $33 | $781 | $1,530 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $548 | $822 | $1,096 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $846 | $846 | $846 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $32 | $32 | $33 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $743 | $901 | $1,060 |
| Total knee replacement CPT 27447 • Orthopedics | $33 | $635 | $1,238 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $535 | $535 | $536 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $202 | $202 | $202 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $49 | $367 | $686 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $32 | $56 | $80 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $681 | $826 | $972 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $104 | $313 | $521 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $352 | $427 | $502 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $485 | $485 | $485 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $33 | $33 | $33 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $995 | $995 | $996 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $170 | $650 | $1,130 |
| Carpal tunnel release CPT 64721 • Orthopedics | $226 | $339 | $452 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $77 | $77 | $77 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $17 | $67 | $116 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $34 | $102 | $170 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $54 | $163 | $271 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $215 | $215 | $215 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $10 | $21 | $32 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $37 | $43 | $49 |