| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $77 | $79 | $80 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $223 | $569 | $914 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $73 | $227 | $381 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $32 | $133 | $233 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $84 | $270 | $456 |
| Excision chalazion single CPT 67800 • Ophthalmology | $24 | $51 | $79 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $447 | $504 | $562 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $98 | $106 | $113 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $40 | $52 | $64 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $62 | $114 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $8 | $38 | $67 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $60 | $89 | $117 |
| Visual field examination CPT 92083 • Ophthalmology | $27 | $42 | $58 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $19 | $22 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $37 | $50 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $21 | $34 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $16 | $22 | $28 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $3 | $22 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $9 | $22 | $36 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,031 | $1,182 | $1,333 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,039 | $1,140 | $1,242 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,126 | $1,287 | $1,449 |
| Total shoulder replacement CPT 23472 • Orthopedics | $257 | $695 | $1,133 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $287 | $776 | $1,264 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $263 | $293 | $323 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $57 | $157 | $257 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $181 | $301 | $422 |
| Total hip replacement CPT 27130 • Orthopedics | $570 | $814 | $1,059 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $222 | $765 | $1,308 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $529 | $730 | $932 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $544 | $752 | $960 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $217 | $588 | $959 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $153 | $529 | $904 |
| Total knee replacement CPT 27447 • Orthopedics | $114 | $586 | $1,057 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $102 | $275 | $447 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $28 | $136 | $243 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $163 | $435 | $707 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $116 | $126 | $136 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $95 | $465 | $835 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $349 | $393 | $437 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $96 | $259 | $421 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $123 | $331 | $539 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $130 | $447 | $765 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $132 | $446 | $759 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $150 | $506 | $861 |
| Carpal tunnel release CPT 64721 • Orthopedics | $204 | $271 | $339 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $74 | $99 | $124 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $20 | $52 | $83 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $15 | $65 | $115 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $47 | $122 | $197 |