| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $245 | $245 | $245 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $231 | $231 | $231 |
| Excision chalazion single CPT 67800 • Ophthalmology | $98 | $98 | $98 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $77 | $77 | $77 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $29 | $29 | $29 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $5 | $5 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $145 | $145 | $145 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $50 | $68 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $37 | $56 | $74 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $19 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $25 | $32 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $24 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $15 | $15 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $5 | $5 | $5 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $53 | $53 | $53 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $44 | $44 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,406 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $30 | $30 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,351 | $1,351 | $1,351 |
| Total shoulder replacement CPT 23472 • Orthopedics | $990 | $990 | $990 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $315 | $315 | $315 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $289 | $350 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $232 | $232 | $232 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $233 | $436 |
| Total hip replacement CPT 27130 • Orthopedics | $941 | $941 | $941 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,224 | $1,224 | $1,224 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $120 | $120 | $120 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $899 | $899 | $899 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,128 | $1,128 | $1,128 |
| Total knee replacement CPT 27447 • Orthopedics | $251 | $752 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $568 | $568 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $30 | $31 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $605 | $605 | $605 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $17 | $23 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $105 | $105 | $105 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $413 | $413 | $413 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $79 | $304 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $472 | $472 | $472 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $669 | $669 | $669 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,075 | $1,075 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $87 | $260 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $24 | $24 | $24 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $194 | $194 | $194 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $137 | $137 | $137 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $19 | $19 | $19 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,716 | $1,716 | $1,716 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $56 | $56 | $56 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $49 |