| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $106 | $106 | $106 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $53 | $53 | $53 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $77 | $77 | $77 |
| Visual field examination CPT 92083 • Ophthalmology | $51 | $51 | $51 |
| Fundus photography CPT 92250 • Ophthalmology | $82 | $82 | $82 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $58 | $58 | $58 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $64 | $64 | $64 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $75 | $75 | $75 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $2,189 | $2,189 | $2,189 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,676 | $1,676 | $1,676 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $281 | $281 | $281 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $375 | $375 | $375 |
| Total hip replacement CPT 27130 • Orthopedics | $3,132 | $3,132 | $3,132 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $2,272 | $2,272 | $2,272 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $2,643 | $2,643 | $2,643 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $2,643 | $2,643 | $2,643 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,484 | $1,484 | $1,484 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Total knee replacement CPT 27447 • Orthopedics | $3,437 | $3,437 | $3,437 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $752 | $752 | $752 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $309 | $309 | $309 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,224 | $1,224 | $1,224 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $1,370 | $1,370 | $1,370 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,772 | $1,772 | $1,772 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $1,370 | $1,370 | $1,370 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $873 | $873 | $873 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $2,500 | $2,500 | $2,500 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $2,384 | $2,384 | $2,384 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $2,782 | $2,782 | $2,782 |
| Carpal tunnel release CPT 64721 • Orthopedics | $668 | $668 | $668 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $406 | $406 | $406 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $596 | $596 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $91 | $91 | $91 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $259 | $259 | $259 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $237 | $237 | $237 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $48 | $48 | $48 |
| Cytopathology concentration technique CPT 88108 • Pathology | $54 | $54 | $54 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $30 | $30 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $32 | $32 | $32 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $14 | $14 | $14 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $39 | $39 | $39 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $133 | $133 | $133 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $211 | $211 | $211 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $3 | $3 | $3 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $56 | $56 | $56 |
| Special stain group II CPT 88313 • Pathology | $13 | $13 | $13 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $118 | $118 | $118 |
| Frozen section pathology each additional CPT 88332 • Pathology | $43 | $43 | $43 |