| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $52 | $79 | $110 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $444 | $934 | $1,441 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $316 | $356 | $397 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $23 | $142 | $262 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $457 | $524 | $591 |
| Excision chalazion single CPT 67800 • Ophthalmology | $62 | $70 | $79 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $540 | $620 | $720 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $55 | $110 | $185 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $62 | $63 | $64 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $8 | $61 | $115 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $44 | $85 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $78 | $96 |
| Visual field examination CPT 92083 • Ophthalmology | $21 | $24 | $27 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $12 | $23 | $38 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $9 | $16 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $29 | $44 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $28 | $41 | $56 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $40 | $47 | $58 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $6 | $37 | $69 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,337 | $1,530 | $1,724 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $201 | $723 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $282 | $1,204 | $1,878 |
| Total shoulder replacement CPT 23472 • Orthopedics | $44 | $444 | $1,136 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,268 | $1,537 | $1,673 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $264 | $346 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $44 | $160 | $257 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $63 | $243 | $423 |
| Total hip replacement CPT 27130 • Orthopedics | $239 | $650 | $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 | $959 | $960 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $154 | $557 | $961 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $180 | $543 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $998 | $1,029 | $1,060 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $449 | $455 | $462 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $24 | $134 | $244 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $108 | $408 | $709 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $113 | $176 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $89 | $463 | $837 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $438 | $516 | $594 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $86 | $254 | $422 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $40 | $290 | $541 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $153 | $647 | $1,022 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $448 | $604 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $40 | $452 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $40 | $190 | $339 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $6 | $65 | $125 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $131 | $198 | $262 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $15 | $68 | $116 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $155 | $176 | $197 |