| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $44 | $87 | $139 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $216 | $566 | $917 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $63 | $223 | $382 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $37 | $135 | $234 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $89 | $273 | $457 |
| Excision chalazion single CPT 67800 • Ophthalmology | $99 | $109 | $120 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $44 | $404 | $720 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $114 | $150 | $185 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $44 | $54 | $64 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $42 | $75 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $47 | $54 | $67 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $54 | $96 |
| Visual field examination CPT 92083 • Ophthalmology | $21 | $35 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $19 | $32 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $5 | $26 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $34 | $38 | $44 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $28 | $34 | $39 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $40 | $42 | $44 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $35 | $51 | $69 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,207 | $1,272 | $1,337 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,135 | $1,190 | $1,245 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,453 | $1,737 | $1,879 |
| Total shoulder replacement CPT 23472 • Orthopedics | $44 | $408 | $1,136 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,255 | $1,261 | $1,268 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $324 | $409 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $44 | $189 | $279 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $219 | $321 | $423 |
| Total hip replacement CPT 27130 • Orthopedics | $44 | $553 | $1,061 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $1,071 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $935 | $1,089 | $1,243 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $256 | $609 | $962 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $128 | $544 | $961 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $180 | $543 | $906 |
| Total knee replacement CPT 27447 • Orthopedics | $932 | $996 | $1,060 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $44 | $246 | $449 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $47 | $204 | $343 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $54 | $381 | $709 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $44 | $119 | $176 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $559 | $698 | $837 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $89 | $264 | $438 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $422 | $426 | $430 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $541 | $633 | $725 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $204 | $485 | $767 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $448 | $604 | $761 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $101 | $482 | $863 |
| Carpal tunnel release CPT 64721 • Orthopedics | $44 | $192 | $339 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $27 | $45 | $65 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $26 | $108 | $199 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $11 | $88 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $26 | $52 | $77 |