| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $178 | $222 | $266 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $45 | $255 | $465 |
| Excision chalazion single CPT 67800 • Ophthalmology | $70 | $70 | $70 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $45 | $45 | $45 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $45 | $57 | $68 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $9 | $36 | $62 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $108 | $108 | $108 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $19 | $19 | $19 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $9 | $50 | $90 |
| Visual field examination CPT 92083 • Ophthalmology | $23 | $23 | $23 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $18 | $18 | $18 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $20 | $29 | $39 |
| Fundus photography CPT 92250 • Ophthalmology | $13 | $29 | $45 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $4 | $4 | $4 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $24 | $35 | $45 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $4 | $32 | $60 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,617 | $1,617 | $1,617 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $221 | $847 | $1,473 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,216 | $1,216 | $1,216 |
| Total shoulder replacement CPT 23472 • Orthopedics | $653 | $653 | $653 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $292 | $292 | $292 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $258 | $258 | $258 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $187 | $187 | $187 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $475 | $475 | $475 |
| Total hip replacement CPT 27130 • Orthopedics | $914 | $1,067 | $1,219 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,130 | $1,318 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,073 | $1,073 | $1,074 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $221 | $221 | $221 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $111 | $111 | $111 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $781 | $910 | $1,040 |
| Total knee replacement CPT 27447 • Orthopedics | $244 | $731 | $1,218 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $51 | $281 | $511 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $27 | $27 | $27 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $78 | $430 | $781 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $32 | $32 | $32 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $45 | $490 | $934 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $250 | $374 | $499 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $240 | $360 | $480 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $94 | $94 | $94 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $441 | $441 | $441 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $678 | $791 | $904 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $103 | $566 | $1,029 |
| Carpal tunnel release CPT 64721 • Orthopedics | $75 | $227 | $378 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $13 | $13 | $13 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $211 | $211 | $211 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $39 | $39 | $39 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $103 | $155 | $206 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $45 | $49 | $53 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $20 | $20 | $20 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $23 | $31 | $40 |