| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $49 | $49 | $49 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $69 | $69 | $69 |
| Excision chalazion single CPT 67800 • Ophthalmology | $20 | $20 | $20 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $771 | $771 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $112 | $127 | $143 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $8 | $8 | $8 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $47 | $47 | $47 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $7 | $7 | $7 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $18 | $18 | $18 |
| Visual field examination CPT 92083 • Ophthalmology | $34 | $47 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $19 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $30 | $30 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $23 | $30 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $35 | $35 | $35 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $11 | $11 | $11 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $63 | $63 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,241 | $1,447 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $773 | $773 | $773 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,351 | $1,575 | $1,800 |
| Total shoulder replacement CPT 23472 • Orthopedics | $707 | $1,061 | $1,414 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,182 | $1,379 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $30 | $94 | $159 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $116 | $349 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $878 | $878 | $878 |
| 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 | $30 | $315 | $600 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $120 | $659 | $1,198 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $226 | $226 | $226 |
| Total knee replacement CPT 27447 • Orthopedics | $877 | $877 | $877 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $57 | $57 | $57 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $199 | $254 | $309 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $100 | $100 | $100 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $85 | $85 | $85 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $784 | $784 | $784 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $55 | $55 | $55 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $106 | $106 | $106 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $101 | $101 | $101 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $493 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $215 | $215 | $215 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $30 | $30 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $8 | $83 | $158 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $79 | $91 | $104 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $40 | $88 | $137 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $38 | $38 | $38 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $587 | $1,144 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $15 | $15 | $15 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $37 | $42 | $48 |