| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $198 | $198 | $198 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $103 | $103 | $103 |
| Excision chalazion single CPT 67800 • Ophthalmology | $22 | $22 | $22 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $504 | $504 | $504 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $119 | $119 | $119 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $4 | $4 | $4 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $22 | $22 | $22 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $7 | $7 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $72 | $72 | $72 |
| Visual field examination CPT 92083 • Ophthalmology | $25 | $29 | $34 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $19 | $23 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $12 | $12 | $12 |
| Fundus photography CPT 92250 • Ophthalmology | $19 | $25 | $30 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $20 | $28 | $36 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $4 | $4 | $4 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $10 | $28 | $46 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,351 | $1,547 | $1,743 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,256 | $1,256 | $1,256 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $948 | $948 | $948 |
| Total shoulder replacement CPT 23472 • Orthopedics | $301 | $301 | $301 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,162 | $1,417 | $1,672 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $351 | $410 | $468 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $30 | $193 | $355 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $95 | $95 | $95 |
| Total hip replacement CPT 27130 • Orthopedics | $153 | $153 | $153 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $952 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $135 | $135 | $135 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $139 | $139 | $139 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $488 | $946 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $120 | $120 | $120 |
| Total knee replacement CPT 27447 • Orthopedics | $1,145 | $1,145 | $1,145 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $325 | $325 | $325 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $240 | $240 | $240 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $195 | $195 | $195 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $37 | $44 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $44 | $44 | $44 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $126 | $126 | $126 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $145 | $145 | $145 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $44 | $44 | $44 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $187 | $187 | $187 |
| Carpal tunnel release CPT 64721 • Orthopedics | $83 | $83 | $83 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $9 | $51 | $93 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $42 | $71 | $99 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $48 | $61 | $74 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $20 | $20 | $20 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,336 | $2,336 | $2,336 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $8 | $26 | $44 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $39 | $44 | $49 |