| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $72 | $114 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $606 | $1,182 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $160 | $420 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $133 | $340 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $30 | $242 | $454 |
| Excision chalazion single CPT 67800 • Ophthalmology | $12 | $71 | $130 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $788 | $804 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $147 | $147 | $147 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $41 | $56 | $71 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $135 | $135 | $135 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $71 | $79 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $64 | $93 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $29 | $31 | $34 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $22 | $29 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $16 | $25 | $30 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $26 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $41 | $41 | $41 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $4 | $32 | $56 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $45 | $57 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,400 | $1,665 | $1,930 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $820 | $1,610 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,820 | $1,839 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,464 | $1,464 | $1,464 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,603 | $1,629 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $420 | $428 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $354 | $354 | $354 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $184 | $284 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $665 | $1,301 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $705 | $1,380 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $423 | $1,210 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $600 | $937 | $1,199 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $637 | $1,243 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $338 | $954 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $453 | $1,300 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $177 | $472 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $199 | $309 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $270 | $749 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $102 | $173 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $382 | $1,086 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $302 | $575 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $335 | $530 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $424 | $674 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $659 | $991 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $331 | $933 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $468 | $905 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $172 | $455 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $75 | $165 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $211 | $250 | $281 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $140 | $140 | $140 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $209 | $247 | $278 |