| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $43 | $87 | $119 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $41 | $601 | $1,161 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $401 | $481 | $541 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $41 | $243 | $357 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $232 | $406 | $579 |
| Excision chalazion single CPT 67800 • Ophthalmology | $41 | $70 | $100 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $41 | $304 | $567 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $93 | $103 | $114 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $34 | $58 | $81 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $13 | $101 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $5 | $59 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $53 | $100 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $50 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $22 | $26 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $45 | $77 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $40 | $44 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $7 | $28 | $42 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $34 | $35 | $37 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $30 | $49 | $61 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $998 | $1,693 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $41 | $809 | $1,577 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $751 | $1,295 | $1,840 |
| Total shoulder replacement CPT 23472 • Orthopedics | $41 | $740 | $1,439 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $942 | $1,274 | $1,606 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $271 | $341 | $411 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $41 | $176 | $311 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $41 | $163 | $285 |
| Total hip replacement CPT 27130 • Orthopedics | $820 | $1,082 | $1,344 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $205 | $933 | $1,661 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $485 | $834 | $1,184 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $100 | $659 | $1,218 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $41 | $629 | $1,217 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $41 | $595 | $1,148 |
| Total knee replacement CPT 27447 • Orthopedics | $41 | $692 | $1,343 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $93 | $331 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $41 | $162 | $283 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $66 | $287 | $508 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $41 | $107 | $173 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $658 | $859 | $1,060 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $41 | $298 | $555 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $105 | $320 | $535 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $397 | $541 | $685 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $161 | $566 | $971 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $41 | $382 | $964 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $88 | $591 | $1,094 |
| Carpal tunnel release CPT 64721 • Orthopedics | $173 | $298 | $424 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $90 | $157 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $219 | $236 | $253 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $136 | $141 | $146 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $22 | $136 | $250 |