| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $166 | $166 | $166 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $70 | $70 | $70 |
| Excision chalazion single CPT 67800 • Ophthalmology | $40 | $40 | $40 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $46 | $46 | $46 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $23 | $23 | $23 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $31 | $31 | $31 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $69 | $69 | $69 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $32 | $32 | $32 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $6 | $6 | $6 |
| Visual field examination CPT 92083 • Ophthalmology | $26 | $26 | $26 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $11 | $11 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $18 | $18 | $18 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $15 | $15 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $31 | $31 | $31 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $16 | $16 | $16 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $41 | $41 | $41 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,132 | $1,132 | $1,132 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $737 | $737 | $737 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $868 | $868 | $868 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,307 | $1,307 | $1,307 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,461 | $1,461 | $1,461 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $276 | $276 | $276 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $27 | $27 | $27 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $203 | $203 | $203 |
| Total hip replacement CPT 27130 • Orthopedics | $244 | $244 | $244 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,055 | $1,055 | $1,055 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $107 | $107 | $107 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $111 | $111 | $111 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $774 | $774 | $774 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $104 | $104 | $104 |
| Total knee replacement CPT 27447 • Orthopedics | $244 | $244 | $244 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $383 | $383 | $383 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $50 | $50 | $50 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $67 | $67 | $67 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $16 | $16 | $16 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $93 | $93 | $93 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $500 | $500 | $500 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $337 | $337 | $337 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $627 | $627 | $627 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $441 | $441 | $441 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $136 | $136 | $136 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $772 | $772 | $772 |
| Carpal tunnel release CPT 64721 • Orthopedics | $264 | $264 | $264 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $72 | $72 | $72 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $211 | $211 | $211 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $39 | $39 | $39 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $155 | $155 | $155 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $53 | $53 | $53 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $8 | $8 | $8 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $31 | $31 | $31 |