| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $33 | $33 | $33 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $120 | $120 | $120 |
| Excision chalazion single CPT 67800 • Ophthalmology | $16 | $16 | $16 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $115 | $115 | $115 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $121 | $121 | $121 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $8 | $8 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $14 | $14 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $9 | $9 | $9 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $38 | $38 | $38 |
| Visual field examination CPT 92083 • Ophthalmology | $65 | $65 | $65 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $17 | $17 | $17 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $92 | $92 | $92 |
| Fundus photography CPT 92250 • Ophthalmology | $23 | $23 | $23 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $3 | $3 | $3 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $8 | $8 | $8 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,080 | $1,080 | $1,080 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $33 | $33 | $33 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,171 | $1,171 | $1,171 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,332 | $1,332 | $1,332 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $149 | $149 | $149 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $403 | $403 | $403 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $206 | $206 | $206 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $109 | $109 | $109 |
| Total hip replacement CPT 27130 • Orthopedics | $1,239 | $1,239 | $1,239 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,530 | $1,530 | $1,530 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $110 | $110 | $110 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $33 | $33 | $33 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $226 | $226 | $226 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $106 | $106 | $106 |
| Total knee replacement CPT 27447 • Orthopedics | $186 | $186 | $186 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $268 | $268 | $268 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $135 | $135 | $135 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $343 | $343 | $343 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $16 | $16 | $16 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $486 | $486 | $486 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $261 | $261 | $261 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $75 | $75 | $75 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $646 | $646 | $646 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $904 | $904 | $904 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $747 | $747 | $747 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $113 | $113 | $113 |
| Carpal tunnel release CPT 64721 • Orthopedics | $317 | $317 | $317 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $78 | $78 | $78 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $41 | $41 | $41 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $171 | $171 | $171 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $271 | $271 | $271 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $65 | $65 | $65 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $7 | $7 | $7 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $37 | $37 | $37 |