| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $658 | $658 | $658 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $300 | $300 | $300 |
| Excision chalazion single CPT 67800 • Ophthalmology | $129 | $129 | $129 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $116 | $116 | $116 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $151 | $151 | $151 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $12 | $12 | $12 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $73 | $73 | $73 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $51 | $51 | $51 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $61 | $61 |
| Visual field examination CPT 92083 • Ophthalmology | $33 | $33 | $33 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $28 | $28 | $28 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $14 | $14 | $14 |
| Fundus photography CPT 92250 • Ophthalmology | $40 | $40 | $40 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $33 | $33 | $33 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $11 | $11 | $11 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,080 | $1,080 | $1,080 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,440 | $1,440 | $1,440 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $251 | $251 | $251 |
| Total shoulder replacement CPT 23472 • Orthopedics | $33 | $33 | $33 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,040 | $1,040 | $1,040 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $282 | $282 | $282 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $221 | $221 | $221 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $59 | $59 | $59 |
| Total hip replacement CPT 27130 • Orthopedics | $33 | $33 | $33 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $153 | $153 | $153 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $33 | $33 | $33 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $790 | $790 | $790 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $226 | $226 | $226 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $106 | $106 | $106 |
| Total knee replacement CPT 27447 • Orthopedics | $186 | $186 | $186 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $33 | $33 | $33 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $40 | $40 | $40 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $73 | $73 | $73 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $16 | $16 | $16 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $146 | $146 | $146 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $52 | $52 | $52 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $75 | $75 | $75 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $646 | $646 | $646 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $90 | $90 | $90 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $996 | $996 | $996 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $226 | $226 | $226 |
| Carpal tunnel release CPT 64721 • Orthopedics | $317 | $317 | $317 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $77 | $77 | $77 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $138 | $138 | $138 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $9 | $9 | $9 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $271 | $271 | $271 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $33 | $33 | $33 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $48 | $48 | $48 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $37 | $37 | $37 |