| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $70 | $95 | $139 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $917 | $999 | $1,081 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $397 | $502 | $607 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $37 | $149 | $262 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $44 | $251 | $457 |
| Excision chalazion single CPT 67800 • Ophthalmology | $24 | $61 | $99 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $44 | $248 | $599 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $90 | $138 | $185 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $12 | $38 | $64 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $115 | $129 | $144 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $9 | $44 | $85 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $48 | $71 |
| Visual field examination CPT 92083 • Ophthalmology | $30 | $39 | $48 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $19 | $27 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $7 | $27 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $26 | $34 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $39 | $51 | $57 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $29 | $35 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $54 | $69 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,293 | $1,315 | $1,337 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,135 | $1,190 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,409 | $1,431 | $1,453 |
| Total shoulder replacement CPT 23472 • Orthopedics | $44 | $744 | $1,136 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,268 | $1,537 | $1,673 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $324 | $388 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $178 | $265 | $372 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $225 | $464 | $666 |
| Total hip replacement CPT 27130 • Orthopedics | $266 | $664 | $1,061 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $1,071 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $44 | $489 | $935 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $44 | $378 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $958 | $959 | $961 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $839 | $873 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $998 | $1,029 | $1,060 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $449 | $532 | $615 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $44 | $105 | $223 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $541 | $625 | $709 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $44 | $104 | $137 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $224 | $530 | $837 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $416 | $427 | $438 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $86 | $254 | $422 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $109 | $325 | $541 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $102 | $434 | $767 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $44 | $402 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $759 | $811 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $44 | $192 | $339 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $65 | $141 | $179 |
| 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 | $8 | $70 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $69 | $73 | $77 |