| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $44 | $44 | $44 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $118 | $118 | $118 |
| Excision chalazion single CPT 67800 • Ophthalmology | $62 | $111 | $159 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $144 | $573 | $1,001 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $145 | $145 | $145 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $22 | $22 | $22 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $13 | $13 | $13 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $27 | $47 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $36 | $36 | $36 |
| Visual field examination CPT 92083 • Ophthalmology | $60 | $60 | $61 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $19 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $19 | $19 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $18 | $18 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $43 | $43 | $43 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $29 | $29 | $29 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $66 | $69 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,293 | $1,293 | $1,293 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,622 | $1,622 | $1,622 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $188 | $1,033 | $1,878 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,127 | $1,315 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $836 | $1,254 | $1,672 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $451 | $451 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $36 | $204 | $372 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $67 | $67 | $67 |
| Total hip replacement CPT 27130 • Orthopedics | $200 | $200 | $200 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $952 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $622 | $622 | $622 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,278 | $1,278 | $1,278 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $44 | $118 | $192 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $839 | $839 | $839 |
| Total knee replacement CPT 27447 • Orthopedics | $932 | $932 | $932 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $44 | $44 | $44 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $220 | $220 | $220 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $81 | $81 | $81 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $176 | $176 | $177 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $112 | $112 | $112 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $89 | $89 | $89 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $430 | $430 | $430 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $44 | $58 | $72 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $767 | $894 | $1,022 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $134 | $134 | $134 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $506 | $506 | $506 |
| Carpal tunnel release CPT 64721 • Orthopedics | $62 | $62 | $62 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $65 | $65 | $65 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $75 | $168 | $262 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $8 | $41 | $74 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $26 | $26 | $26 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $44 | $141 | $239 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $8 | $26 | $44 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $36 | $36 | $36 |