| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $37 | $37 | $37 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $591 | $591 | $591 |
| Excision chalazion single CPT 67800 • Ophthalmology | $62 | $62 | $62 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $150 | $150 | $150 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $93 | $93 | $93 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $83 | $83 | $83 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $13 | $13 | $13 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $9 | $9 | $9 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $12 | $12 |
| Visual field examination CPT 92083 • Ophthalmology | $25 | $25 | $25 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $24 | $24 | $24 |
| 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 | $11 | $11 | $11 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $44 | $44 | $44 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $35 | $35 | $35 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,293 | $1,293 | $1,293 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $324 | $324 | $324 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $376 | $376 | $376 |
| Total shoulder replacement CPT 23472 • Orthopedics | $44 | $44 | $44 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $335 | $335 | $335 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $338 | $338 | $338 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $267 | $267 | $267 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $100 | $100 | $100 |
| Total hip replacement CPT 27130 • Orthopedics | $133 | $133 | $133 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $173 | $173 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $622 | $622 | $622 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $256 | $256 | $256 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $255 | $255 | $255 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $599 | $599 | $599 |
| Total knee replacement CPT 27447 • Orthopedics | $133 | $133 | $133 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $615 | $615 | $615 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $34 | $34 | $34 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $44 | $44 | $44 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $27 | $27 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $168 | $168 | $168 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $44 | $44 | $44 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $401 | $401 | $401 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $362 | $362 | $362 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $716 | $716 | $716 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $672 | $672 | $672 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $708 | $708 | $708 |
| Carpal tunnel release CPT 64721 • Orthopedics | $85 | $85 | $85 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $44 | $44 | $44 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $131 | $131 | $131 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $102 | $102 | $102 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $39 | $39 | $39 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $39 | $39 | $39 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $37 | $37 | $37 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $36 | $36 | $36 |