| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $17 | $46 | $77 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $917 | $963 | $1,009 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $397 | $420 | $443 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $208 | $235 | $262 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $443 | $450 | $457 |
| Excision chalazion single CPT 67800 • Ophthalmology | $99 | $105 | $112 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $44 | $498 | $1,002 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $72 | $124 | $185 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $22 | $43 | $64 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $115 | $134 | $144 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $43 | $65 | $85 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $72 | $84 | $96 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $21 | $27 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $19 | $27 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $24 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $17 | $26 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $6 | $30 | $44 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $6 | $23 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $7 | $30 | $46 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,337 | $1,530 | $1,724 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $324 | $785 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $376 | $914 | $1,453 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,127 | $1,256 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $167 | $1,036 | $1,672 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $316 | $364 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $37 | $218 | $372 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $100 | $261 | $423 |
| Total hip replacement CPT 27130 • Orthopedics | $666 | $864 | $1,061 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $1,071 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $124 | $529 | $935 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $44 | $350 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $958 | $959 | $961 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $839 | $873 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $932 | $996 | $1,060 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $62 | $255 | $449 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $44 | $148 | $244 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $709 | $841 | $974 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $18 | $110 | $176 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $168 | $502 | $837 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $297 | $368 | $438 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $422 | $426 | $430 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $44 | $364 | $541 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $102 | $434 | $767 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $179 | $470 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $202 | $533 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $83 | $209 | $335 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $9 | $67 | $125 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $99 | $165 | $199 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $56 | $86 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $46 | $122 | $197 |