| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $163 | $163 | $163 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $231 | $231 | $231 |
| Excision chalazion single CPT 67800 • Ophthalmology | $69 | $69 | $69 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $772 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $23 | $23 | $23 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $5 | $5 | $5 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $14 | $14 | $14 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $49 | $49 | $50 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $74 | $98 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $30 | $30 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $15 | $27 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $30 | $30 |
| Fundus photography CPT 92250 • Ophthalmology | $15 | $15 | $15 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $52 | $52 | $52 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $40 | $40 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $4 | $4 | $4 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,158 | $1,406 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $309 | $309 | $309 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $270 | $270 | $270 |
| Total shoulder replacement CPT 23472 • Orthopedics | $141 | $141 | $141 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $158 | $158 | $158 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $238 | $238 | $238 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $285 | $285 | $285 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $30 | $30 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,632 | $1,632 | $1,632 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $615 | $1,199 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $839 | $839 | $839 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,128 | $1,128 | $1,128 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $642 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $426 | $426 | $426 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $213 | $213 | $213 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $432 | $432 | $432 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $17 | $93 | $169 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $523 | $523 | $523 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $55 | $55 | $55 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $265 | $397 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $67 | $67 | $67 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $478 | $478 | $478 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $712 | $712 | $712 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $319 | $376 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $80 | $80 | $80 |
| 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 | $40 | $40 | $40 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $97 | $97 | $97 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $343 | $343 | $343 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $74 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $49 |