| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $82 | $95 | $109 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $129 | $228 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $40 | $50 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $88 | $146 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $347 | $404 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $87 | $105 | $123 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $154 | $154 | $154 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $71 | $92 | $112 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $44 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $22 | $22 | $22 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $9 | $9 | $9 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $12 | $12 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $43 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $39 | $39 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $33 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $35 | $35 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $5 | $5 | $5 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $11 | $20 | $30 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $47 | $47 | $47 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,241 | $1,447 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $788 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,351 | $1,575 | $1,800 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,061 | $1,061 | $1,061 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,103 | $1,103 | $1,103 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $238 | $238 | $238 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $157 | $285 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $140 | $251 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $831 | $1,632 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $102 | $175 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $135 | $240 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $614 | $1,198 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $71 | $113 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $30 | $30 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $299 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $36 | $43 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $65 | $100 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $381 | $732 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $56 | $83 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $41 | $53 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $67 | $67 | $67 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $478 | $717 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $62 | $95 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $37 | $43 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $24 | $24 | $24 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $52 | $155 | $258 |
| 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 | $49 | $151 | $254 |