| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $37 | $37 | $37 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $50 | $50 | $50 |
| Fundus photography CPT 92250 • Ophthalmology | $22 | $22 | $22 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $97 | $97 | $97 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $76 | $88 | $100 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $57 | $57 | $57 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $3,110 | $3,110 | $3,110 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $2,905 | $2,905 | $2,905 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,608 | $2,497 | $3,386 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,963 | $2,963 | $2,963 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $775 | $775 | $775 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $1,094 | $1,094 | $1,094 |
| Total hip replacement CPT 27130 • Orthopedics | $2,359 | $2,359 | $2,359 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $3,067 | $3,067 | $3,067 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $2,192 | $2,192 | $2,192 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $2,255 | $2,255 | $2,255 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $2,254 | $2,254 | $2,254 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $2,120 | $2,120 | $2,120 |
| Total knee replacement CPT 27447 • Orthopedics | $1,138 | $1,747 | $2,357 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $512 | $790 | $1,068 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $581 | $581 | $581 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $814 | $1,220 | $1,626 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,966 | $1,966 | $1,966 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,034 | $1,034 | $1,034 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $481 | $739 | $996 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,268 | $1,268 | $1,268 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,797 | $1,797 | $1,797 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,784 | $1,784 | $1,784 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $2,022 | $2,022 | $2,022 |
| Carpal tunnel release CPT 64721 • Orthopedics | $814 | $814 | $814 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $148 | $148 | $148 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $486 | $486 | $486 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $150 | $150 | $150 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $479 | $479 | $479 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $4,301 | $4,301 | $4,301 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $105 | $122 | $139 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $69 | $81 | $92 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $457 | $457 | $457 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $95 | $95 | $95 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $321 | $321 | $321 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $167 | $167 | $167 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $282 | $282 | $282 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $392 | $606 | $821 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $161 | $161 | $162 |
| Cytopathology concentration technique CPT 88108 • Pathology | $43 | $43 | $43 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $46 | $46 | $46 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $31 | $38 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |