| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $55 | $113 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $799 | $970 | $1,141 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $72 | $306 | $541 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $58 | $208 | $357 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $15 | $15 | $15 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $540 | $540 | $540 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $85 | $85 | $85 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $12 | $12 | $12 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $47 | $95 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $49 | $74 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $75 | $100 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $45 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $25 | $30 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $24 | $29 |
| Fundus photography CPT 92250 • Ophthalmology | $20 | $29 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $52 | $52 | $52 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $8 | $8 | $8 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $22 | $42 | $61 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,586 | $1,946 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $155 | $155 | $155 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $270 | $1,035 | $1,800 |
| Total shoulder replacement CPT 23472 • Orthopedics | $141 | $141 | $141 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,103 | $1,103 | $1,103 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $361 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $332 | $332 | $332 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Total hip replacement CPT 27130 • Orthopedics | $125 | $125 | $125 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,632 | $1,632 | $1,632 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $117 | $117 | $117 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $180 | $180 | $180 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $240 | $240 | $240 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $169 | $169 | $169 |
| Total knee replacement CPT 27447 • Orthopedics | $251 | $752 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $85 | $85 | $85 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $232 | $232 | $232 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $432 | $432 | $432 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $157 | $157 | $157 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $53 | $291 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $101 | $101 | $101 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $350 | $669 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $712 | $873 | $1,035 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $85 | $259 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $16 | $87 | $157 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $105 | $105 | $105 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $16 | $16 | $16 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $15 | $15 | $15 |