| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $748 | $873 | $997 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $90 | $345 | $600 |
| Excision chalazion single CPT 67800 • Ophthalmology | $32 | $55 | $78 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $77 | $77 | $77 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $24 | $88 | $151 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $42 | $80 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $10 | $10 | $10 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $84 | $84 | $85 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $8 | $42 | $76 |
| Visual field examination CPT 92083 • Ophthalmology | $27 | $30 | $33 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $27 | $36 | $45 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $14 | $53 | $92 |
| Fundus photography CPT 92250 • Ophthalmology | $16 | $37 | $57 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $33 | $38 | $44 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $26 | $46 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $28 | $28 | $28 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,157 | $1,350 | $1,542 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,008 | $1,223 | $1,439 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,171 | $1,171 | $1,171 |
| Total shoulder replacement CPT 23472 • Orthopedics | $666 | $666 | $666 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $149 | $149 | $149 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $282 | $282 | $282 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $59 | $59 | $59 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $44 | $44 | $44 |
| Total hip replacement CPT 27130 • Orthopedics | $186 | $712 | $1,239 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $153 | $842 | $1,530 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $110 | $603 | $1,096 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $33 | $33 | $33 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $33 | $33 | $33 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $33 | $546 | $1,060 |
| Total knee replacement CPT 27447 • Orthopedics | $929 | $1,084 | $1,238 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $375 | $455 | $535 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $225 | $225 | $225 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $49 | $367 | $686 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $119 | $119 | $119 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $486 | $729 | $972 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $391 | $456 | $521 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $75 | $289 | $502 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $65 | $65 | $65 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $181 | $542 | $904 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $995 | $995 | $996 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,130 | $1,130 | $1,131 |
| Carpal tunnel release CPT 64721 • Orthopedics | $314 | $383 | $452 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $78 | $78 | $78 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $17 | $17 | $17 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $70 | $70 | $70 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $11 | $141 | $271 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $43 | $43 | $43 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $65 | $76 | $86 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $35 | $42 | $49 |