| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $81 | $81 | $81 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $710 | $710 | $710 |
| Excision chalazion single CPT 67800 • Ophthalmology | $77 | $89 | $101 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $705 | $705 | $705 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $81 | $81 | $81 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $23 | $23 | $23 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $73 | $109 | $145 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $9 | $9 | $9 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $12 | $67 | $121 |
| Visual field examination CPT 92083 • Ophthalmology | $27 | $27 | $27 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $27 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $8 | $8 | $8 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $28 | $42 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $4 | $4 | $4 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $11 | $11 | $11 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $22 | $22 | $22 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,752 | $1,850 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $338 | $338 | $338 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Total shoulder replacement CPT 23472 • Orthopedics | $283 | $283 | $283 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $309 | $309 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $42 | $140 | $238 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $285 | $285 | $285 |
| Total hip replacement CPT 27130 • Orthopedics | $125 | $125 | $125 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,095 | $1,095 | $1,095 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $249 | $249 | $249 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $899 | $1,088 | $1,277 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $180 | $180 | $180 |
| Total knee replacement CPT 27447 • Orthopedics | $930 | $930 | $930 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $455 | $455 | $455 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $216 | $280 | $343 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $730 | $730 | $730 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $36 | $42 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $811 | $811 | $811 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $58 | $58 | $58 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $44 | $44 | $44 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $67 | $67 | $67 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $204 | $204 | $204 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $949 | $949 | $949 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $100 | $100 | $100 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $12 | $12 | $12 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $21 | $147 | $272 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $40 | $40 | $40 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $127 | $127 | $127 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $229 | $229 | $229 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $8 | $8 | $8 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $29 | $41 | $53 |