| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $33 | $33 | $33 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $90 | $90 | $90 |
| Excision chalazion single CPT 67800 • Ophthalmology | $123 | $123 | $123 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $77 | $77 | $77 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $30 | $30 | $30 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $23 | $23 | $23 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $96 | $96 | $96 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $7 | $7 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $122 | $122 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $33 | $33 | $33 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $25 | $25 | $25 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $24 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $15 | $15 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $5 | $5 | $5 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $5 | $5 | $5 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $47 | $47 | $47 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,543 | $1,543 | $1,543 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,545 | $1,545 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $900 | $900 | $900 |
| Total shoulder replacement CPT 23472 • Orthopedics | $283 | $283 | $283 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $158 | $158 | $158 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $309 | $309 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $249 | $249 | $249 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $407 | $407 | $407 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $30 | $30 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $245 | $245 | $245 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $175 | $175 | $175 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $955 | $955 | $955 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $839 | $839 | $839 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $169 | $169 | $169 |
| Total knee replacement CPT 27447 • Orthopedics | $188 | $188 | $188 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $398 | $398 | $398 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $31 | $31 | $31 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $649 | $649 | $649 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $16 | $16 | $16 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $157 | $157 | $157 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $435 | $435 | $435 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $33 | $33 | $33 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $72 | $72 | $72 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $191 | $191 | $191 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $474 | $474 | $474 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,131 | $1,131 | $1,131 |
| Carpal tunnel release CPT 64721 • Orthopedics | $425 | $425 | $425 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $32 | $32 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $58 | $58 | $58 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $21 | $21 | $21 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $255 | $255 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $41 | $41 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $41 | $41 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $33 | $33 | $33 |