| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $312 | $312 | $312 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $59 | $59 | $59 |
| Excision chalazion single CPT 67800 • Ophthalmology | $124 | $142 | $160 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $72 | $537 | $1,001 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $101 | $123 | $144 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $7 | $7 | $7 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $14 | $14 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $24 | $54 | $85 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $91 | $121 |
| Visual field examination CPT 92083 • Ophthalmology | $12 | $12 | $12 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $23 | $23 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $5 | $5 | $5 |
| Fundus photography CPT 92250 • Ophthalmology | $35 | $35 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $4 | $45 | $96 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $38 | $38 | $38 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $60 | $89 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,207 | $1,935 | $2,663 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $243 | $243 | $243 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,409 | $1,409 | $1,409 |
| Total shoulder replacement CPT 23472 • Orthopedics | $301 | $902 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $251 | $961 | $1,672 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $338 | $395 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $44 | $200 | $355 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $235 | $235 | $235 |
| Total hip replacement CPT 27130 • Orthopedics | $1,332 | $1,650 | $1,968 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $952 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $187 | $187 | $187 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $895 | $895 | $895 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $639 | $639 | $639 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $899 | $1,379 | $1,859 |
| Total knee replacement CPT 27447 • Orthopedics | $280 | $639 | $998 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $462 | $462 | $462 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $44 | $44 | $44 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $379 | $379 | $379 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $107 | $251 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $44 | $44 | $44 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $119 | $119 | $119 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $44 | $465 | $886 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $44 | $203 | $362 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $767 | $767 | $767 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $90 | $793 | $1,496 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $708 | $708 | $708 |
| Carpal tunnel release CPT 64721 • Orthopedics | $312 | $514 | $717 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $44 | $44 | $44 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $10 | $136 | $262 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $38 | $87 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $93 | $93 | $93 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $358 | $358 | $358 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $6 | $64 | $146 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $23 | $23 | $23 |