| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $76 | $107 | $139 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $144 | $530 | $917 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $61 | $221 | $382 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $37 | $149 | $262 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $414 | $435 | $457 |
| Excision chalazion single CPT 67800 • Ophthalmology | $99 | $111 | $124 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $44 | $229 | $599 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $72 | $124 | $185 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $12 | $38 | $64 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $72 | $79 | $89 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $43 | $52 | $67 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $36 | $56 | $71 |
| Visual field examination CPT 92083 • Ophthalmology | $25 | $26 | $27 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $24 | $38 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $10 | $29 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $16 | $17 | $18 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $36 | $44 | $57 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $4 | $22 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $35 | $42 | $48 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,293 | $1,315 | $1,337 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $324 | $785 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,409 | $1,580 | $1,878 |
| Total shoulder replacement CPT 23472 • Orthopedics | $44 | $644 | $1,136 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,255 | $1,261 | $1,268 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $316 | $320 | $324 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $37 | $217 | $355 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $423 | $445 | $466 |
| Total hip replacement CPT 27130 • Orthopedics | $933 | $997 | $1,061 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $1,071 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $187 | $561 | $935 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $44 | $503 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $961 | $1,119 | $1,277 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $599 | $753 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $133 | $597 | $1,060 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $44 | $246 | $449 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $44 | $113 | $244 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $146 | $427 | $709 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $44 | $104 | $137 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $112 | $474 | $837 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $119 | $279 | $438 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $287 | $354 | $422 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $44 | $292 | $541 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $44 | $321 | $767 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $672 | $716 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $202 | $533 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $297 | $316 | $335 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $18 | $71 | $125 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $75 | $179 | $262 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $20 | $53 | $74 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $46 | $62 | $77 |