| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $170 | $170 | $170 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $44 | $44 | $44 |
| Excision chalazion single CPT 67800 • Ophthalmology | $10 | $10 | $10 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $417 | $417 | $417 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $22 | $22 | $22 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $62 | $62 | $62 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $76 | $76 | $76 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $20 | $43 | $65 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $30 | $62 | $94 |
| Visual field examination CPT 92083 • Ophthalmology | $10 | $10 | $10 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $11 | $21 | $31 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $24 | $24 | $24 |
| Fundus photography CPT 92250 • Ophthalmology | $26 | $34 | $42 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $3 | $3 | $3 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $23 | $23 | $23 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $21 | $30 | $40 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,122 | $1,122 | $1,122 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $201 | $201 | $201 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,179 | $1,432 | $1,684 |
| Total shoulder replacement CPT 23472 • Orthopedics | $620 | $620 | $620 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,457 | $1,457 | $1,457 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $246 | $299 | $351 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $99 | $99 | $99 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $40 | $176 | $311 |
| Total hip replacement CPT 27130 • Orthopedics | $179 | $179 | $179 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $698 | $698 | $698 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $687 | $687 | $687 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $40 | $373 | $707 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $40 | $532 | $1,023 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $40 | $40 | $40 |
| Total knee replacement CPT 27447 • Orthopedics | $638 | $638 | $638 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $46 | $46 | $46 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $32 | $36 | $40 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $300 | $300 | $300 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $541 | $541 | $541 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $620 | $620 | $620 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $390 | $390 | $390 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $52 | $52 | $52 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $40 | $40 | $40 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $40 | $426 | $811 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $80 | $80 | $80 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $184 | $184 | $184 |
| Carpal tunnel release CPT 64721 • Orthopedics | $232 | $232 | $232 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $6 | $6 | $6 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $20 | $115 | $211 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $16 | $16 | $16 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $155 | $155 | $155 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $40 | $40 | $40 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $56 | $68 | $80 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $24 | $24 | $24 |