| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $182 | $182 | $182 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $107 | $107 | $107 |
| Excision chalazion single CPT 67800 • Ophthalmology | $25 | $25 | $25 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $451 | $451 | $451 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $123 | $123 | $123 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $5 | $5 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $113 | $113 | $113 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $6 | $6 | $6 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $60 | $60 | $60 |
| Visual field examination CPT 92083 • Ophthalmology | $24 | $24 | $24 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $15 | $15 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $53 | $53 | $53 |
| Fundus photography CPT 92250 • Ophthalmology | $14 | $14 | $14 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $18 | $18 | $18 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $37 | $37 | $37 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $12 | $12 | $12 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,296 | $1,296 | $1,296 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $845 | $845 | $845 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $992 | $992 | $992 |
| Total shoulder replacement CPT 23472 • Orthopedics | $752 | $752 | $752 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $252 | $252 | $252 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $306 | $306 | $306 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $47 | $47 | $47 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $42 | $42 | $42 |
| Total hip replacement CPT 27130 • Orthopedics | $1,401 | $1,401 | $1,401 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,298 | $1,298 | $1,298 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $865 | $865 | $865 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $891 | $891 | $891 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $954 | $954 | $954 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $599 | $599 | $599 |
| Total knee replacement CPT 27447 • Orthopedics | $700 | $700 | $700 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $59 | $59 | $59 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $225 | $225 | $225 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $260 | $260 | $260 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $18 | $18 | $18 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $42 | $42 | $42 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $406 | $406 | $406 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $84 | $84 | $84 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $109 | $109 | $109 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $509 | $509 | $509 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $237 | $237 | $237 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $135 | $135 | $135 |
| Carpal tunnel release CPT 64721 • Orthopedics | $51 | $51 | $51 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $24 | $24 | $24 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $288 | $288 | $288 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $76 | $76 | $76 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $115 | $115 | $115 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,537 | $1,537 | $1,537 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $69 | $69 | $69 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $29 | $29 | $29 |