| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $218 | $218 | $218 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $88 | $88 | $88 |
| Excision chalazion single CPT 67800 • Ophthalmology | $146 | $146 | $146 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $303 | $303 | $303 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $30 | $30 | $30 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $83 | $83 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $128 | $128 | $128 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $12 | $12 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $26 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $39 | $39 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $7 | $7 | $7 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $36 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $4 | $4 | $4 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $13 | $13 | $13 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,255 | $1,255 | $1,255 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $270 | $270 | $270 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,414 | $1,414 | $1,414 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,291 | $1,291 | $1,291 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $657 | $657 | $657 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $538 | $538 | $538 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $624 | $624 | $624 |
| Total hip replacement CPT 27130 • Orthopedics | $878 | $878 | $878 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $326 | $326 | $326 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,847 | $1,847 | $1,847 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $120 | $120 | $120 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $120 | $120 | $120 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $30 | $30 |
| Total knee replacement CPT 27447 • Orthopedics | $1,486 | $1,486 | $1,486 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $57 | $57 | $57 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $75 | $75 | $75 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $649 | $649 | $649 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $53 | $53 | $53 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $825 | $825 | $825 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $55 | $55 | $55 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $112 | $112 | $112 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $537 | $537 | $537 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $717 | $717 | $717 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $703 | $703 | $703 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,075 | $1,075 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $319 | $319 | $319 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $16 | $16 | $16 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $39 | $39 | $39 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $40 | $40 | $40 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $255 | $255 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,602 | $1,602 | $1,602 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $33 | $33 | $33 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $37 | $37 | $37 |