| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $487 | $801 | $1,115 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $413 | $482 | $550 |
| Excision chalazion single CPT 67800 • Ophthalmology | $89 | $89 | $89 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $656 | $656 | $656 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $28 | $28 | $28 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $32 | $42 | $52 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $34 | $34 | $34 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $8 | $21 | $34 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $8 | $30 | $52 |
| Visual field examination CPT 92083 • Ophthalmology | $58 | $58 | $58 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $34 | $34 | $35 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $21 | $40 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $33 | $51 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $8 | $32 | $56 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $39 | $39 | $39 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,419 | $1,656 | $1,892 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $244 | $936 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,002 | $2,002 | $2,002 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,166 | $1,166 | $1,166 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $884 | $884 | $884 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $337 | $393 | $449 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $42 | $42 | $42 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $86 | $86 | $86 |
| Total hip replacement CPT 27130 • Orthopedics | $224 | $857 | $1,491 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $871 | $1,306 | $1,741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $183 | $703 | $1,222 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,257 | $1,257 | $1,257 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $986 | $986 | $986 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $34 | $595 | $1,156 |
| Total knee replacement CPT 27447 • Orthopedics | $1,119 | $1,358 | $1,598 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $579 | $579 | $580 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $307 | $307 | $307 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $147 | $442 | $736 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $103 | $103 | $103 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $842 | $983 | $1,123 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $351 | $526 | $701 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $327 | $490 | $653 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $495 | $495 | $495 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $717 | $717 | $717 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $148 | $566 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $168 | $643 | $1,118 |
| Carpal tunnel release CPT 64721 • Orthopedics | $297 | $360 | $424 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $14 | $14 | $14 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $60 | $60 | $60 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $19 | $97 | $175 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $55 | $167 | $278 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $82 | $82 | $82 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $7 | $7 | $7 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $47 | $54 |