| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $55 | $82 | $103 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,142 | $1,181 | $1,221 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $278 | $433 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $126 | $319 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $92 | $358 | $518 |
| Excision chalazion single CPT 67800 • Ophthalmology | $49 | $74 | $99 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $386 | $492 | $599 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $113 | $132 | $151 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $46 | $87 | $133 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $70 | $130 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $43 | $55 | $67 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $78 | $96 |
| Visual field examination CPT 92083 • Ophthalmology | $21 | $26 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $22 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $5 | $36 | $54 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $13 | $17 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $7 | $27 | $48 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $5 | $32 | $62 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $7 | $34 | $60 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,481 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $558 | $1,411 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $270 | $1,665 | $3,059 |
| Total shoulder replacement CPT 23472 • Orthopedics | $990 | $1,252 | $1,513 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,545 | $1,561 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $289 | $486 | $683 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $223 | $378 | $533 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $63 | $407 | $875 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $818 | $2,235 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $1,186 | $2,713 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $635 | $1,059 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $733 | $1,990 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $899 | $994 | $1,089 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $728 | $1,128 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $783 | $2,193 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $274 | $508 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $220 | $367 | $514 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $624 | $1,466 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $92 | $155 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $699 | $1,046 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $294 | $438 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $390 | $874 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $472 | $542 | $613 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $717 | $826 | $935 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $614 | $949 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $626 | $1,818 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $245 | $385 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $17 | $48 | $79 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $39 | $166 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $80 | $108 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $38 | $178 | $254 |