| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $61 | $61 | $61 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $103 | $113 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $65 | $76 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $76 | $94 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $41 | $56 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $39 | $39 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $63 | $79 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $43 | $69 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $47 | $47 | $47 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $36 | $45 | $49 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $42 | $56 | $65 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,850 | $1,850 | $1,850 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,689 | $1,689 | $1,689 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,892 | $1,983 |
| Total shoulder replacement CPT 23472 • Orthopedics | $283 | $893 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,103 | $1,391 | $1,679 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $425 | $437 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $42 | $187 | $332 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $298 | $566 |
| Total hip replacement CPT 27130 • Orthopedics | $1,255 | $1,352 | $1,401 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $175 | $882 | $1,236 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,199 | $1,224 | $1,272 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,272 | $1,272 | $1,272 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $808 | $1,197 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $943 | $1,400 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $402 | $588 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $284 | $303 | $321 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $261 | $566 | $719 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $25 | $104 | $182 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,046 | $1,069 | $1,080 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $579 | $579 | $579 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $552 | $556 | $558 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $377 | $724 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $524 | $1,018 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $801 | $1,186 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,353 | $1,353 | $1,353 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $347 | $505 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $8 | $83 | $161 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $277 | $287 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $179 | $179 | $179 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $15 | $193 | $282 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $61 | $799 | $1,537 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $4 | $48 | $91 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $25 | $44 | $53 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $252 | $252 | $252 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $57 | $100 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $198 | $198 | $198 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $67 | $88 | $99 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $167 | $175 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $437 | $465 | $479 |