| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $18 | $57 | $96 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $825 | $993 | $1,161 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $262 | $502 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $140 | $332 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $69 | $370 | $579 |
| Excision chalazion single CPT 67800 • Ophthalmology | $93 | $109 | $125 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $113 | $340 | $567 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $23 | $93 | $144 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $69 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $110 | $145 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $29 | $50 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $32 | $76 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $27 | $30 | $34 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $18 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $10 | $39 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $29 | $44 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $35 | $40 | $49 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $30 | $45 | $53 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $13 | $37 | $61 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,241 | $1,529 | $1,693 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $546 | $1,577 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $270 | $1,303 | $1,840 |
| Total shoulder replacement CPT 23472 • Orthopedics | $990 | $1,215 | $1,439 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,103 | $1,354 | $1,606 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $360 | $411 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $159 | $243 | $326 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $57 | $171 | $285 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $667 | $1,344 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $972 | $1,661 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $482 | $1,184 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $180 | $866 | $1,218 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $476 | $1,217 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $468 | $1,148 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $520 | $1,343 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $237 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $179 | $309 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $434 | $898 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $25 | $122 | $173 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $416 | $1,060 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $232 | $555 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $224 | $535 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $67 | $475 | $685 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $143 | $690 | $971 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $489 | $964 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $625 | $1,094 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $182 | $430 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $95 | $158 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $16 | $175 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $12 | $58 | $83 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $51 | $185 | $254 |