| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $200 | $233 | $266 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $233 | $349 | $465 |
| Excision chalazion single CPT 67800 • Ophthalmology | $56 | $56 | $56 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $94 | $94 | $94 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $17 | $31 | $45 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $31 | $47 | $62 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $69 | $88 | $107 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $6 | $6 | $6 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $6 | $6 | $6 |
| Visual field examination CPT 92083 • Ophthalmology | $23 | $23 | $23 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $11 | $11 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $18 | $28 | $39 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $30 | $45 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $3 | $3 | $3 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $4 | $4 | $4 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $8 | $8 | $8 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,132 | $1,375 | $1,617 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,105 | $1,289 | $1,473 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $347 | $347 | $347 |
| Total shoulder replacement CPT 23472 • Orthopedics | $261 | $261 | $261 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $146 | $146 | $146 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $369 | $369 | $369 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $282 | $282 | $282 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $54 | $54 | $54 |
| Total hip replacement CPT 27130 • Orthopedics | $183 | $701 | $1,219 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $753 | $1,130 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $161 | $617 | $1,073 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $774 | $774 | $774 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $221 | $221 | $221 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $45 | $543 | $1,040 |
| Total knee replacement CPT 27447 • Orthopedics | $1,218 | $1,218 | $1,218 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $511 | $511 | $511 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $45 | $45 | $45 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $445 | $613 | $781 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $16 | $16 | $16 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $934 | $934 | $934 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $350 | $424 | $499 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $96 | $288 | $480 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $314 | $314 | $314 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $617 | $749 | $881 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $45 | $475 | $904 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $206 | $617 | $1,029 |
| Carpal tunnel release CPT 64721 • Orthopedics | $378 | $378 | $379 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $67 | $67 | $67 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $32 | $32 | $32 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $20 | $20 | $20 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $18 | $112 | $206 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $45 | $45 | $45 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $14 | $14 | $14 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $40 | $41 |