| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $44 | $44 | $44 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $443 | $443 | $443 |
| Excision chalazion single CPT 67800 • Ophthalmology | $87 | $143 | $198 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $540 | $630 | $720 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $93 | $139 | $185 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $22 | $22 | $22 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $52 | $89 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $27 | $47 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $11 | $92 | $173 |
| Visual field examination CPT 92083 • Ophthalmology | $61 | $61 | $61 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $19 | $23 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $7 | $7 | $7 |
| Fundus photography CPT 92250 • Ophthalmology | $19 | $32 | $44 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $11 | $11 | $11 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $51 | $51 | $51 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $35 | $52 | $69 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,293 | $1,706 | $2,119 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $811 | $811 | $811 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $939 | $1,409 | $1,878 |
| Total shoulder replacement CPT 23472 • Orthopedics | $44 | $47 | $51 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $408 | $1,040 | $1,672 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $382 | $416 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $355 | $364 | $372 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $162 | $162 | $162 |
| Total hip replacement CPT 27130 • Orthopedics | $1,220 | $1,220 | $1,220 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $211 | $971 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $622 | $622 | $622 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $895 | $895 | $895 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $639 | $639 | $639 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $219 | $219 | $219 |
| Total knee replacement CPT 27447 • Orthopedics | $44 | $44 | $44 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $149 | $149 | $149 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $44 | $44 | $44 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $97 | $97 | $97 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $44 | $103 | $162 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $204 | $204 | $204 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $119 | $119 | $119 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $44 | $44 | $44 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $44 | $94 | $145 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $44 | $533 | $1,022 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $122 | $122 | $122 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $506 | $506 | $506 |
| Carpal tunnel release CPT 64721 • Orthopedics | $425 | $425 | $425 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $27 | $27 | $27 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $26 | $144 | $262 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $19 | $78 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $39 | $39 | $39 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $364 | $364 | $364 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $56 | $65 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $61 | $61 | $62 |