| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $77 | $108 | $139 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $144 | $834 | $1,441 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $382 | $508 | $633 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $55 | $158 | $262 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $295 | $376 | $457 |
| Excision chalazion single CPT 67800 • Ophthalmology | $79 | $108 | $159 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $72 | $464 | $720 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $19 | $66 | $114 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $44 | $54 | $64 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $13 | $64 | $115 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $40 | $45 | $48 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $60 | $91 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $36 | $42 | $48 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $23 | $31 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $22 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $16 | $23 | $34 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $37 | $38 | $39 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $4 | $22 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $45 | $48 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,207 | $1,272 | $1,337 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $162 | $704 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,409 | $1,431 | $1,453 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,127 | $1,256 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $251 | $1,063 | $1,672 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $324 | $331 | $338 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $44 | $220 | $372 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $63 | $243 | $423 |
| Total hip replacement CPT 27130 • Orthopedics | $666 | $864 | $1,061 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $1,071 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $249 | $592 | $935 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $895 | $928 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $894 | $928 | $961 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $839 | $873 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $932 | $996 | $1,060 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $431 | $440 | $449 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $69 | $202 | $313 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $709 | $841 | $974 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $18 | $110 | $176 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $837 | $838 | $839 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $438 | $516 | $594 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $57 | $240 | $422 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $362 | $542 | $724 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $102 | $434 | $767 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $44 | $402 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $152 | $508 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $318 | $329 | $339 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $43 | $84 | $125 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $50 | $116 | $199 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $116 | $129 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $69 | $133 | $197 |