| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $160 | $160 | $160 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $558 | $558 | $558 |
| Excision chalazion single CPT 67800 • Ophthalmology | $10 | $10 | $10 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $562 | $562 | $562 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $77 | $77 | $77 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $40 | $40 | $40 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $14 | $14 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $12 | $12 | $12 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $7 | $7 | $7 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $26 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $24 | $24 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $25 | $25 | $25 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $7 | $7 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $5 | $5 | $5 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $43 | $43 | $43 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,473 | $1,473 | $1,473 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $692 | $692 | $692 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $804 | $804 | $804 |
| Total shoulder replacement CPT 23472 • Orthopedics | $642 | $642 | $642 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,003 | $1,003 | $1,003 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $281 | $281 | $281 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $285 | $285 | $285 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $26 | $26 | $26 |
| Total hip replacement CPT 27130 • Orthopedics | $228 | $228 | $228 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $148 | $148 | $148 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $740 | $740 | $740 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $762 | $762 | $762 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $109 | $109 | $109 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $102 | $102 | $102 |
| Total knee replacement CPT 27447 • Orthopedics | $797 | $797 | $797 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $358 | $358 | $358 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $192 | $192 | $192 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $92 | $92 | $92 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $116 | $116 | $116 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $474 | $474 | $474 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $75 | $75 | $75 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $481 | $481 | $481 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $123 | $123 | $123 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $608 | $608 | $608 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $662 | $662 | $662 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $750 | $750 | $750 |
| Carpal tunnel release CPT 64721 • Orthopedics | $401 | $401 | $401 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $74 | $74 | $74 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $76 | $76 | $76 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $101 | $101 | $101 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $123 | $123 | $123 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $293 | $293 | $293 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $36 | $36 | $36 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $46 | $46 | $46 |