| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $163 | $245 | $326 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $92 | $277 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $93 | $93 | $93 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $772 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $21 | $21 | $21 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $12 | $48 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $119 | $145 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $50 | $50 | $50 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $8 | $65 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $47 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $14 | $15 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $39 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $21 | $28 | $35 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $26 | $26 | $26 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $27 | $32 | $36 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $63 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,241 | $1,447 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,545 | $1,545 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $900 | $900 | $900 |
| Total shoulder replacement CPT 23472 • Orthopedics | $707 | $707 | $707 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,182 | $1,182 | $1,182 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $64 | $64 | $64 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $116 | $116 | $116 |
| Total hip replacement CPT 27130 • Orthopedics | $125 | $690 | $1,254 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,224 | $1,427 | $1,631 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $117 | $641 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $900 | $900 | $900 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $180 | $689 | $1,198 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $113 | $620 | $1,127 |
| Total knee replacement CPT 27447 • Orthopedics | $877 | $1,065 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $568 | $568 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $57 | $57 | $57 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $173 | $336 | $500 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $169 | $169 | $169 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $209 | $627 | $1,045 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $110 | $330 | $550 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $53 | $291 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $135 | $135 | $135 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $478 | $717 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $712 | $830 | $948 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $108 | $591 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $298 | $365 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $32 | $32 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $26 | $26 | $26 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $16 | $16 | $16 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $19 | $137 | $254 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $284 | $284 | $284 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $4 | $39 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $49 |