| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $227 | $357 | $486 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $333 | $333 | $333 |
| Excision chalazion single CPT 67800 • Ophthalmology | $12 | $12 | $12 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $328 | $328 | $328 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $63 | $79 | $87 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $6 | $6 | $6 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $11 | $79 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $6 | $45 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $92 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $21 | $43 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $22 | $31 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $34 | $40 |
| Fundus photography CPT 92250 • Ophthalmology | $8 | $20 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $32 | $32 | $32 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $46 | $56 | $69 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $31 | $49 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,603 | $1,775 | $1,946 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,288 | $1,314 | $1,340 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $337 | $1,194 | $1,684 |
| Total shoulder replacement CPT 23472 • Orthopedics | $248 | $248 | $248 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,020 | $1,020 | $1,020 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $264 | $264 | $264 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $139 | $139 | $139 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $41 | $136 | $231 |
| Total hip replacement CPT 27130 • Orthopedics | $140 | $518 | $895 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $977 | $977 | $977 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $40 | $40 | $40 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $40 | $398 | $757 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,023 | $1,023 | $1,023 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $914 | $914 | $914 |
| Total knee replacement CPT 27447 • Orthopedics | $893 | $1,006 | $1,119 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $69 | $69 | $69 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $40 | $74 | $108 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $273 | $273 | $273 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $81 | $251 | $541 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $443 | $656 | $869 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $84 | $84 | $84 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $52 | $52 | $52 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $423 | $423 | $423 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $40 | $61 | $81 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $161 | $598 | $1,035 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $138 | $297 | $456 |
| Carpal tunnel release CPT 64721 • Orthopedics | $167 | $360 | $552 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $29 | $121 | $213 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $158 | $196 | $219 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $8 | $42 | $77 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $13 | $126 | $239 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $50 | $50 | $50 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $40 | $60 | $80 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $30 | $30 | $30 |