| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $146 | $146 | $146 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $46 | $46 | $46 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $30 | $30 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $424 | $424 | $424 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $17 | $68 | $120 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $42 | $42 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $45 | $80 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $25 | $50 | $76 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $68 | $74 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $47 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $14 | $19 | $25 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $30 | $30 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $36 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $18 | $18 | $18 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $11 | $20 | $30 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $13 | $13 | $13 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $155 | $155 | $155 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $270 | $270 | $270 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,219 | $1,219 | $1,219 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,103 | $1,103 | $1,103 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $309 | $332 | $355 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $166 | $229 | $292 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $306 | $582 |
| Total hip replacement CPT 27130 • Orthopedics | $125 | $125 | $125 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $163 | $163 | $163 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $233 | $233 | $233 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $600 | $600 | $600 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $180 | $180 | $180 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $169 | $169 | $169 |
| Total knee replacement CPT 27447 • Orthopedics | $217 | $217 | $217 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $57 | $57 | $57 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $309 | $309 | $309 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $605 | $605 | $605 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $452 | $452 | $452 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $239 | $239 | $239 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $337 | $461 | $584 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $191 | $191 | $191 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $108 | $108 | $108 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $30 | $30 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $12 | $21 | $30 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $26 | $57 | $88 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $12 | $12 | $12 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $38 | $38 | $38 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $41 | $41 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $31 | $31 | $31 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $37 | $42 | $48 |