| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $62 | $94 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $154 | $837 | $1,441 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $483 | $487 | $495 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $33 | $207 | $326 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $323 | $448 | $557 |
| Excision chalazion single CPT 67800 • Ophthalmology | $98 | $114 | $123 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $566 | $766 | $1,001 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $21 | $92 | $142 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $55 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $10 | $72 | $114 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $13 | $48 | $82 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $74 | $98 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $30 | $39 | $48 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $12 | $30 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $30 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $16 | $17 | $20 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $6 | $27 | $48 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $29 | $35 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $7 | $37 | $58 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,333 | $1,547 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $1,031 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $939 | $1,355 | $1,771 |
| Total shoulder replacement CPT 23472 • Orthopedics | $30 | $973 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,171 | $1,369 | $1,672 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $395 | $404 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $44 | $144 | $314 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $133 | $379 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $266 | $938 | $1,294 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,599 | $1,653 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $778 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $601 | $1,173 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $542 | $959 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $564 | $932 | $1,127 |
| Total knee replacement CPT 27447 • Orthopedics | $44 | $785 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $114 | $376 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $137 | $243 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $112 | $440 | $707 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $18 | $77 | $136 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $105 | $723 | $1,045 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $275 | $421 | $550 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $79 | $343 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $506 | $523 | $539 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $716 | $740 | $765 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $579 | $948 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $227 | $721 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $334 | $400 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $9 | $80 | $152 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $53 | $78 | $99 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $27 | $93 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $25 | $159 | $254 |