| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $296 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $50 | $71 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $384 | $738 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $176 | $322 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $212 | $269 | $326 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $284 | $284 | $284 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $55 | $81 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $498 | $635 | $771 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $91 | $91 | $91 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $53 | $72 | $91 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $94 | $94 | $94 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $56 | $75 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $79 | $101 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $23 | $25 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $30 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $11 | $36 | $67 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $22 | $30 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $22 | $37 | $51 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $23 | $41 | $70 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $29 | $43 | $58 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,080 | $1,638 | $2,195 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,002 | $1,002 | $1,002 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,147 | $1,474 | $1,801 |
| Total shoulder replacement CPT 23472 • Orthopedics | $911 | $911 | $911 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,013 | $1,294 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $267 | $396 | $509 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $223 | $223 | $223 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $109 | $188 |
| Total hip replacement CPT 27130 • Orthopedics | $810 | $810 | $810 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,052 | $1,052 | $1,052 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $392 | $755 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $403 | $776 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $775 | $775 | $775 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $378 | $725 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $419 | $809 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $370 | $447 | $523 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $178 | $299 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $178 | $326 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $56 | $107 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $353 | $677 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $359 | $359 | $359 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $346 | $417 | $488 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $462 | $917 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $323 | $617 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $307 | $584 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $705 | $705 | $705 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $155 | $280 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $41 | $52 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $165 | $217 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $49 | $49 | $49 |