| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $781 | $948 | $1,115 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $110 | $330 | $550 |
| Excision chalazion single CPT 67800 • Ophthalmology | $18 | $57 | $96 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $34 | $345 | $656 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $105 | $105 | $105 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $16 | $34 | $52 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $49 | $49 | $49 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $8 | $21 | $34 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $5 | $5 | $5 |
| Visual field examination CPT 92083 • Ophthalmology | $39 | $49 | $58 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $12 | $23 | $35 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $12 | $36 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $38 | $56 | $75 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $42 | $42 | $42 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $6 | $6 | $6 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $8 | $8 | $8 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,419 | $1,656 | $1,892 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,140 | $1,383 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,401 | $1,401 | $1,401 |
| Total shoulder replacement CPT 23472 • Orthopedics | $156 | $156 | $156 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,237 | $1,237 | $1,237 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $449 | $449 | $449 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $25 | $25 | $25 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $575 | $575 | $575 |
| Total hip replacement CPT 27130 • Orthopedics | $1,044 | $1,268 | $1,491 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $871 | $1,306 | $1,741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $611 | $917 | $1,222 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $629 | $629 | $629 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $920 | $920 | $920 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $116 | $636 | $1,156 |
| Total knee replacement CPT 27447 • Orthopedics | $1,598 | $1,598 | $1,598 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $435 | $507 | $579 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $192 | $192 | $192 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $516 | $626 | $736 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $138 | $138 | $138 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $168 | $646 | $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 | $354 | $354 | $354 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $205 | $205 | $205 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $98 | $541 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $839 | $979 | $1,118 |
| Carpal tunnel release CPT 64721 • Orthopedics | $211 | $318 | $424 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $71 | $71 | $71 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $28 | $28 | $28 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $18 | $18 | $18 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $17 | $147 | $278 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $41 | $41 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $80 | $80 | $80 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $47 | $54 |