| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $918 | $918 | $918 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $486 | $486 | $486 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $320 | $320 | $320 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $364 | $364 | $364 |
| Excision chalazion single CPT 67800 • Ophthalmology | $81 | $81 | $81 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $752 | $752 | $752 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $97 | $97 | $97 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $49 | $49 | $49 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $52 | $52 | $52 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $54 | $54 | $54 |
| Visual field examination CPT 92083 • Ophthalmology | $15 | $15 | $15 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $9 | $9 | $9 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $11 | $11 | $11 |
| Fundus photography CPT 92250 • Ophthalmology | $10 | $10 | $10 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $47 | $47 | $47 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $48 | $48 | $48 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $57 | $57 | $57 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,311 | $1,311 | $1,311 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,199 | $1,199 | $1,199 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,389 | $1,389 | $1,389 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,063 | $1,063 | $1,063 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,176 | $1,176 | $1,176 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $318 | $318 | $318 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $326 | $326 | $326 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $536 | $536 | $536 |
| Total hip replacement CPT 27130 • Orthopedics | $950 | $950 | $950 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,229 | $1,229 | $1,229 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $893 | $893 | $893 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $919 | $919 | $919 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $916 | $916 | $916 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $858 | $858 | $858 |
| Total knee replacement CPT 27447 • Orthopedics | $948 | $948 | $948 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $467 | $467 | $467 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $246 | $246 | $246 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $743 | $743 | $743 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $119 | $119 | $119 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $801 | $801 | $801 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $440 | $440 | $440 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $426 | $426 | $426 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $529 | $529 | $529 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $730 | $730 | $730 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $534 | $534 | $534 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $631 | $631 | $631 |
| Carpal tunnel release CPT 64721 • Orthopedics | $254 | $254 | $254 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $148 | $148 | $148 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $56 | $56 | $56 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $43 | $43 | $43 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $52 | $52 | $52 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $221 | $221 | $221 |