| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $163 | $163 | $163 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $347 | $347 | $347 |
| Excision chalazion single CPT 67800 • Ophthalmology | $71 | $71 | $71 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $30 | $30 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $17 | $17 | $17 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $7 | $7 | $7 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $77 | $145 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $43 | $51 | $59 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $85 | $103 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $26 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $19 | $25 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $24 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $20 | $28 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $18 | $18 | $18 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $4 | $4 | $4 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $7 | $7 | $7 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,406 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,159 | $1,159 | $1,159 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $360 | $931 | $1,501 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,061 | $1,130 | $1,199 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $236 | $236 | $236 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $309 | $309 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $66 | $173 | $279 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $142 | $142 | $142 |
| Total hip replacement CPT 27130 • Orthopedics | $125 | $125 | $125 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,142 | $1,142 | $1,142 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $117 | $117 | $117 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $900 | $959 | $1,019 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,199 | $1,199 | $1,199 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $670 | $670 | $670 |
| Total knee replacement CPT 27447 • Orthopedics | $1,253 | $1,253 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $568 | $568 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $155 | $155 | $155 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $75 | $75 | $75 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $110 | $110 | $110 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $337 | $337 | $337 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $478 | $478 | $478 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $82 | $82 | $82 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $108 | $108 | $108 |
| Carpal tunnel release CPT 64721 • Orthopedics | $85 | $85 | $85 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $14 | $14 | $14 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $21 | $128 | $236 |
| 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 | $25 | $25 | $25 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $53 | $53 | $53 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $41 | $41 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $29 | $38 | $48 |