| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $81 | $81 | $81 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $542 | $542 | $542 |
| Excision chalazion single CPT 67800 • Ophthalmology | $78 | $78 | $78 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $529 | $529 | $529 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $28 | $28 | $28 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $42 | $42 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $7 | $7 | $7 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $6 | $6 | $6 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $5 | $5 | $5 |
| Visual field examination CPT 92083 • Ophthalmology | $40 | $40 | $40 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $18 | $18 | $18 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $32 | $32 | $32 |
| Fundus photography CPT 92250 • Ophthalmology | $18 | $18 | $18 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $8 | $8 | $8 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $7 | $7 | $7 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $44 | $44 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,205 | $1,205 | $1,205 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,195 | $1,195 | $1,195 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,824 | $1,824 | $1,824 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,004 | $1,004 | $1,004 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,197 | $1,197 | $1,197 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $417 | $417 | $417 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $52 | $52 | $52 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $295 | $295 | $295 |
| Total hip replacement CPT 27130 • Orthopedics | $255 | $255 | $255 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $249 | $249 | $249 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $119 | $119 | $119 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $122 | $122 | $122 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $610 | $610 | $610 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $114 | $114 | $114 |
| Total knee replacement CPT 27447 • Orthopedics | $255 | $255 | $255 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $436 | $436 | $436 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $225 | $225 | $225 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $500 | $500 | $500 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $25 | $25 | $25 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $160 | $160 | $160 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $564 | $564 | $564 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $543 | $543 | $543 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $690 | $690 | $690 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $194 | $194 | $194 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $92 | $92 | $92 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $776 | $776 | $776 |
| Carpal tunnel release CPT 64721 • Orthopedics | $89 | $89 | $89 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $32 | $32 |
| 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 | $14 | $14 | $14 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $71 | $71 | $71 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,711 | $1,711 | $1,711 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $4 | $4 | $4 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $32 | $32 | $32 |