| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $55 | $55 | $55 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $295 | $295 | $295 |
| Excision chalazion single CPT 67800 • Ophthalmology | $160 | $160 | $160 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $720 | $861 | $1,001 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $101 | $101 | $101 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $44 | $44 | $44 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $9 | $9 | $9 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $47 | $47 | $48 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $61 | $66 | $71 |
| Visual field examination CPT 92083 • Ophthalmology | $30 | $30 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $38 | $38 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $7 | $7 | $7 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $13 | $19 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $28 | $42 | $56 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $6 | $22 | $38 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $10 | $28 | $46 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,207 | $1,207 | $1,207 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,216 | $1,216 | $1,216 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $188 | $1,033 | $1,878 |
| Total shoulder replacement CPT 23472 • Orthopedics | $150 | $827 | $1,503 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,673 | $1,673 | $1,673 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $451 | $451 | $451 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $355 | $364 | $372 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $333 | $333 | $333 |
| Total hip replacement CPT 27130 • Orthopedics | $44 | $44 | $44 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $173 | $952 | $1,730 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,243 | $1,243 | $1,243 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $959 | $959 | $959 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $958 | $958 | $958 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $599 | $599 | $599 |
| Total knee replacement CPT 27447 • Orthopedics | $932 | $932 | $932 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $44 | $44 | $44 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $157 | $157 | $157 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $97 | $97 | $97 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $35 | $40 | $44 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $839 | $839 | $839 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $594 | $594 | $594 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $57 | $57 | $57 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $44 | $44 | $44 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $44 | $99 | $153 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $90 | $90 | $90 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $506 | $506 | $506 |
| Carpal tunnel release CPT 64721 • Orthopedics | $425 | $425 | $425 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $65 | $65 | $65 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $99 | $148 | $197 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $14 | $75 | $136 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $19 | $19 | $19 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $388 | $388 | $388 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $20 | $32 | $44 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $36 | $36 | $36 |