| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $262 | $339 | $416 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $443 | $450 | $457 |
| Excision chalazion single CPT 67800 • Ophthalmology | $99 | $105 | $112 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $72 | $336 | $599 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $108 | $111 | $114 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $22 | $29 | $36 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $22 | $48 | $75 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $24 | $46 | $67 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $78 | $96 |
| Visual field examination CPT 92083 • Ophthalmology | $21 | $28 | $36 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $12 | $13 | $15 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $28 | $38 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $31 | $44 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $6 | $22 | $39 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $40 | $42 | $44 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $36 | $40 | $44 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,337 | $1,530 | $1,724 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $162 | $704 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $282 | $867 | $1,453 |
| Total shoulder replacement CPT 23472 • Orthopedics | $44 | $590 | $1,136 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $167 | $717 | $1,268 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $324 | $388 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $37 | $147 | $257 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $157 | $290 | $423 |
| Total hip replacement CPT 27130 • Orthopedics | $266 | $664 | $1,061 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $742 | $1,311 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $932 | $934 | $935 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $256 | $609 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $894 | $928 | $961 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $839 | $873 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $266 | $663 | $1,060 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $431 | $440 | $449 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $223 | $229 | $235 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $146 | $273 | $401 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $82 | $137 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $112 | $474 | $837 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $438 | $516 | $594 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $422 | $426 | $430 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $541 | $633 | $725 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $102 | $434 | $767 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $627 | $694 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $202 | $533 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $212 | $276 | $339 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $125 | $152 | $179 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $131 | $165 | $199 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $15 | $40 | $66 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $77 | $136 | $195 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $194 | $830 | $1,467 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $59 | $67 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $27 | $29 | $31 |