| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $46 | $62 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $733 | $795 | $856 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $281 | $495 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $58 | $252 | $510 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $366 | $414 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $79 | $101 | $124 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $479 | $625 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $91 | $116 | $142 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $51 | $65 | $80 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $92 | $92 | $92 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $35 | $57 | $83 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $18 | $55 | $77 |
| Visual field examination CPT 92083 • Ophthalmology | $22 | $24 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $22 | $37 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $31 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $20 | $30 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $31 | $31 | $31 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $27 | $30 | $32 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $29 | $46 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,069 | $1,362 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $996 | $1,271 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,162 | $1,481 | $1,801 |
| Total shoulder replacement CPT 23472 • Orthopedics | $212 | $561 | $909 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $315 | $665 | $1,014 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $259 | $336 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $206 | $206 | $206 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $316 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $188 | $764 | $1,254 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,049 | $1,340 | $1,631 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $748 | $910 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $770 | $835 | $900 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $769 | $769 | $769 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $113 | $655 | $1,127 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $710 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $319 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $195 | $206 | $216 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $250 | $439 | $567 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $109 | $139 | $169 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $581 | $1,045 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $351 | $450 | $550 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $338 | $466 | $530 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $231 | $433 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $322 | $613 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $529 | $948 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $691 | $883 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $244 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $8 | $30 | $52 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $160 | $209 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $92 | $92 | $92 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $62 | $148 | $254 |