| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $974 | $974 | $974 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $34 | $34 | $34 |
| Excision chalazion single CPT 67800 • Ophthalmology | $119 | $119 | $119 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $656 | $656 | $656 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $21 | $21 | $21 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $32 | $32 | $32 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $10 | $10 | $10 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $3 | $3 | $3 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $8 | $8 | $8 |
| Visual field examination CPT 92083 • Ophthalmology | $58 | $58 | $58 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $35 | $35 | $35 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $9 | $9 | $9 |
| Fundus photography CPT 92250 • Ophthalmology | $34 | $34 | $34 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $6 | $6 | $6 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $6 | $6 | $6 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $79 | $79 | $79 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,324 | $1,324 | $1,324 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $814 | $814 | $814 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $300 | $300 | $300 |
| Total shoulder replacement CPT 23472 • Orthopedics | $311 | $311 | $311 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,326 | $1,326 | $1,326 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $314 | $314 | $314 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $211 | $211 | $211 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $115 | $115 | $115 |
| Total hip replacement CPT 27130 • Orthopedics | $746 | $746 | $746 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $871 | $871 | $871 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $34 | $34 | $34 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $34 | $34 | $34 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $131 | $131 | $131 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $116 | $116 | $116 |
| Total knee replacement CPT 27447 • Orthopedics | $240 | $240 | $240 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $435 | $435 | $435 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $153 | $153 | $153 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $34 | $34 | $34 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $69 | $69 | $69 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $562 | $562 | $562 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $491 | $491 | $491 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $327 | $327 | $327 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $34 | $34 | $34 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,024 | $1,024 | $1,024 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $689 | $689 | $689 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $839 | $839 | $839 |
| Carpal tunnel release CPT 64721 • Orthopedics | $211 | $211 | $211 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $28 | $28 | $28 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $12 | $12 | $12 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $48 | $48 | $48 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $28 | $28 | $28 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $82 | $82 | $82 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $7 | $7 | $7 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $54 | $54 | $54 |