| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $366 | $366 | $366 |
| Excision chalazion single CPT 67800 • Ophthalmology | $79 | $79 | $79 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $479 | $479 | $479 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $91 | $91 | $91 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $51 | $51 | $51 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $92 | $92 | $92 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $32 | $32 | $32 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $77 | $77 | $77 |
| Visual field examination CPT 92083 • Ophthalmology | $22 | $22 | $22 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $16 | $16 | $16 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $38 | $38 | $38 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $14 | $14 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $31 | $31 | $31 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $32 | $32 | $32 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $29 | $29 | $29 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,069 | $1,069 | $1,069 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $996 | $996 | $996 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,162 | $1,162 | $1,162 |
| Total shoulder replacement CPT 23472 • Orthopedics | $909 | $909 | $909 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,014 | $1,014 | $1,014 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $259 | $259 | $259 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $206 | $206 | $206 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $338 | $338 | $338 |
| Total hip replacement CPT 27130 • Orthopedics | $849 | $849 | $849 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,049 | $1,049 | $1,049 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $748 | $748 | $748 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $770 | $770 | $770 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $769 | $769 | $769 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $725 | $725 | $725 |
| Total knee replacement CPT 27447 • Orthopedics | $848 | $848 | $848 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $359 | $359 | $359 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $195 | $195 | $195 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $321 | $321 | $321 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $109 | $109 | $109 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $669 | $669 | $669 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $351 | $351 | $351 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $338 | $338 | $338 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $433 | $433 | $433 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $613 | $613 | $613 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $609 | $609 | $609 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $691 | $691 | $691 |
| Carpal tunnel release CPT 64721 • Orthopedics | $272 | $272 | $272 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $52 | $52 | $52 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $160 | $160 | $160 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $53 | $53 | $53 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $62 | $62 | $62 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,173 | $1,173 | $1,173 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $27 | $27 | $27 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $30 | $30 | $30 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $70 | $70 | $70 |