| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $728 | $728 | $728 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $315 | $315 | $315 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $208 | $208 | $208 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $363 | $363 | $363 |
| Excision chalazion single CPT 67800 • Ophthalmology | $63 | $63 | $63 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $475 | $475 | $475 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $90 | $90 | $90 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $51 | $51 | $51 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $60 | $60 | $60 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $32 | $32 | $32 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $76 | $76 | $76 |
| Visual field examination CPT 92083 • Ophthalmology | $17 | $17 | $17 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $25 | $25 | $25 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $19 | $19 | $19 |
| Fundus photography CPT 92250 • Ophthalmology | $27 | $27 | $27 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $22 | $22 | $22 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $23 | $23 | $23 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $28 | $28 | $28 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,050 | $1,050 | $1,050 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $980 | $980 | $980 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,142 | $1,142 | $1,142 |
| Total shoulder replacement CPT 23472 • Orthopedics | $897 | $897 | $897 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,001 | $1,001 | $1,001 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $257 | $257 | $257 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $204 | $204 | $204 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $335 | $335 | $335 |
| Total hip replacement CPT 27130 • Orthopedics | $838 | $838 | $838 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,035 | $1,035 | $1,035 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $738 | $738 | $738 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $759 | $759 | $759 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $759 | $759 | $759 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $716 | $716 | $716 |
| Total knee replacement CPT 27447 • Orthopedics | $837 | $837 | $837 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $354 | $354 | $354 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $177 | $177 | $177 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $562 | $562 | $562 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $108 | $108 | $108 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $661 | $661 | $661 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $346 | $346 | $346 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $334 | $334 | $334 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $427 | $427 | $427 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $605 | $605 | $605 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $598 | $598 | $598 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $679 | $679 | $679 |
| Carpal tunnel release CPT 64721 • Orthopedics | $268 | $268 | $268 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $99 | $99 | $99 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $66 | $66 | $66 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $52 | $52 | $52 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $61 | $61 | $61 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,163 | $1,163 | $1,163 |