| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $42 | $42 | $42 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $414 | $414 | $414 |
| Excision chalazion single CPT 67800 • Ophthalmology | $93 | $93 | $93 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $540 | $540 | $540 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $130 | $130 | $130 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $42 | $42 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $14 | $14 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $24 | $24 | $24 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $36 | $36 | $36 |
| Visual field examination CPT 92083 • Ophthalmology | $36 | $36 | $36 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $39 | $39 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $48 | $48 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $20 | $20 | $20 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $59 | $59 | $59 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $14 | $14 | $14 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,207 | $1,207 | $1,207 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,216 | $1,216 | $1,216 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $188 | $188 | $188 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,503 | $1,503 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $335 | $335 | $335 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $451 | $451 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $355 | $355 | $355 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $67 | $67 | $67 |
| Total hip replacement CPT 27130 • Orthopedics | $44 | $44 | $44 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $173 | $173 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $249 | $249 | $249 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $128 | $128 | $128 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $128 | $128 | $128 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $899 | $899 | $899 |
| Total knee replacement CPT 27447 • Orthopedics | $666 | $666 | $666 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $462 | $462 | $462 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $52 | $52 | $52 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $97 | $97 | $97 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $27 | $27 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,118 | $1,118 | $1,118 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $89 | $89 | $89 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $287 | $287 | $287 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $725 | $725 | $725 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $44 | $44 | $44 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $44 | $44 | $44 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,012 | $1,012 | $1,012 |
| Carpal tunnel release CPT 64721 • Orthopedics | $297 | $297 | $297 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $9 | $9 | $9 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $26 | $26 | $26 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $14 | $14 | $14 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $39 | $39 | $39 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $291 | $291 | $291 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $56 | $56 | $56 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $23 | $23 | $23 |