| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $20 | $49 | $77 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $917 | $1,022 | $1,141 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $74 | $235 | $397 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $234 | $263 | $291 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $231 | $344 | $457 |
| Excision chalazion single CPT 67800 • Ophthalmology | $99 | $129 | $160 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $116 | $357 | $599 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $79 | $96 | $114 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $7 | $22 | $36 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $62 | $115 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $49 | $58 | $67 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $78 | $96 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $17 | $21 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $19 | $31 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $8 | $16 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $28 | $35 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $27 | $28 | $28 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $29 | $41 | $53 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $6 | $29 | $44 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,262 | $1,418 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,159 | $1,202 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,351 | $1,402 | $1,453 |
| Total shoulder replacement CPT 23472 • Orthopedics | $212 | $674 | $1,136 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,268 | $1,422 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $319 | $356 | $425 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $56 | $151 | $245 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $87 | $255 | $423 |
| Total hip replacement CPT 27130 • Orthopedics | $640 | $851 | $1,061 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $166 | $1,069 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $583 | $759 | $935 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $639 | $801 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $495 | $961 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $846 | $876 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $1,060 | $1,157 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $284 | $366 | $449 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $47 | $145 | $244 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $605 | $657 | $709 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $126 | $131 | $137 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $732 | $784 | $837 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $234 | $438 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $386 | $404 | $422 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $432 | $724 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $44 | $611 | $1,022 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $135 | $448 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $542 | $703 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $339 | $394 | $448 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $9 | $37 | $65 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $52 | $171 | $262 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $66 | $73 | $80 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $15 | $106 | $197 |