| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $138 | $144 | $150 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $82 | $86 | $90 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $116 | $123 | $131 |
| Visual field examination CPT 92083 • Ophthalmology | $58 | $63 | $67 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $31 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $55 | $84 |
| Fundus photography CPT 92250 • Ophthalmology | $30 | $42 | $59 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $53 | $60 | $66 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $30 | $45 | $55 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $56 | $65 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $473 | $1,108 | $1,743 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $356 | $992 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $358 | $1,351 | $1,895 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,488 | $2,255 | $3,021 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $396 | $1,210 | $1,659 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $369 | $405 | $432 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $260 | $305 | $350 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $352 | $613 |
| Total hip replacement CPT 27130 • Orthopedics | $338 | $830 | $1,321 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $372 | $1,044 | $1,716 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $1,253 | $2,503 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $511 | $1,262 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,261 | $1,285 | $1,309 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $1,023 | $1,854 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $1,046 | $1,790 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $380 | $595 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $316 | $620 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $682 | $1,073 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $187 | $355 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $473 | $1,100 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $499 | $540 | $580 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $530 | $586 | $669 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $731 | $1,452 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $409 | $1,006 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $676 | $1,001 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,133 | $1,137 | $1,141 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $471 | $927 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $91 | $171 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $148 | $228 | $279 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $149 | $156 | $164 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $137 | $222 | $275 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $1,075 | $2,335 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $76 | $118 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $29 | $42 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $116 | $187 | $257 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $84 | $115 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $184 | $185 | $187 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $70 | $84 | $94 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $160 | $173 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $398 | $423 | $437 |