| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $21 | $52 | $82 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $223 | $599 | $975 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $325 | $404 | $483 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $160 | $252 | $319 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $484 | $533 | $558 |
| Excision chalazion single CPT 67800 • Ophthalmology | $24 | $54 | $84 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $55 | $410 | $626 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $11 | $65 | $119 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $7 | $51 | $79 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $68 | $121 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $25 | $43 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $65 | $91 | $117 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $32 | $57 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $19 | $23 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $33 | $50 |
| Fundus photography CPT 92250 • Ophthalmology | $16 | $23 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $32 | $37 | $41 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $25 | $34 | $42 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $11 | $31 | $50 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,105 | $1,322 | $1,473 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $208 | $964 | $1,384 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $241 | $878 | $1,514 |
| Total shoulder replacement CPT 23472 • Orthopedics | $128 | $870 | $1,284 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,003 | $1,257 | $1,432 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $263 | $302 | $341 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $214 | $251 | $285 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $52 | $248 | $433 |
| Total hip replacement CPT 27130 • Orthopedics | $570 | $942 | $1,139 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $740 | $1,200 | $1,480 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $740 | $926 | $1,057 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $109 | $560 | $1,011 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $544 | $777 | $1,010 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $767 | $915 | $1,023 |
| Total knee replacement CPT 27447 • Orthopedics | $114 | $789 | $1,137 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $358 | $447 | $512 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $180 | $238 | $280 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $92 | $548 | $813 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $31 | $88 | $145 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $879 | $925 | $949 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $374 | $444 | $498 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $337 | $420 | $481 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $92 | $330 | $567 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $130 | $468 | $806 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $618 | $763 | $882 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $897 | $966 | $1,000 |
| Carpal tunnel release CPT 64721 • Orthopedics | $81 | $281 | $407 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $22 | $46 | $69 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $10 | $108 | $207 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $38 | $98 | $135 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $25 | $118 | $246 |