| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $741 | $871 | $1,000 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $430 | $455 | $480 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $34 | $159 | $284 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $55 | $276 | $496 |
| Excision chalazion single CPT 67800 • Ophthalmology | $24 | $65 | $106 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $54 | $269 | $483 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $14 | $56 | $98 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $37 | $69 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $10 | $47 | $83 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $34 | $54 | $73 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $26 | $47 | $67 |
| Visual field examination CPT 92083 • Ophthalmology | $53 | $55 | $58 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $22 | $28 | $34 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $6 | $16 | $26 |
| Fundus photography CPT 92250 • Ophthalmology | $34 | $38 | $41 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $8 | $44 | $84 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $9 | $43 | $77 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $12 | $53 | $99 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $377 | $1,227 | $1,892 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $163 | $740 | $1,317 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $300 | $918 | $1,535 |
| Total shoulder replacement CPT 23472 • Orthopedics | $156 | $1,187 | $2,194 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $884 | $1,118 | $1,352 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $347 | $398 | $449 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $126 | $192 | $257 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $208 | $389 | $495 |
| Total hip replacement CPT 27130 • Orthopedics | $1,044 | $1,377 | $1,957 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,219 | $1,308 | $1,396 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $856 | $926 | $996 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $943 | $984 | $1,025 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $197 | $611 | $1,024 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $34 | $500 | $965 |
| Total knee replacement CPT 27447 • Orthopedics | $160 | $518 | $1,129 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $479 | $530 | $580 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $31 | $292 | $611 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $34 | $234 | $435 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $147 | $246 | $344 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $225 | $449 | $881 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $105 | $286 | $466 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $34 | $306 | $449 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $34 | $307 | $580 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $220 | $517 | $819 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $689 | $999 | $1,506 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $910 | $1,015 | $1,119 |
| Carpal tunnel release CPT 64721 • Orthopedics | $34 | $375 | $734 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $11 | $71 | $132 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $60 | $146 | $208 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $127 | $129 | $132 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $11 | $108 | $205 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $681 | $1,322 |