| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $686 | $686 | $687 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $50 | $50 | $50 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $50 | $50 | $50 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $703 | $703 | $703 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $463 | $463 | $463 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $656 | $656 | $656 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,101 | $1,101 | $1,101 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $160 | $160 | $160 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $65 | $65 | $65 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $73 | $73 | $73 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $31 | $31 | $31 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $38 | $38 | $38 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $50 | $50 | $50 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $50 | $50 | $50 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $9 | $9 | $9 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,687 | $1,687 | $1,687 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,583 | $1,583 | $1,583 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,839 | $1,839 | $1,839 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $432 | $432 | $432 |
| Total hip replacement CPT 27130 • Orthopedics | $1,297 | $1,297 | $1,297 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,686 | $1,686 | $1,686 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,207 | $1,207 | $1,207 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,166 | $1,166 | $1,166 |
| Total knee replacement CPT 27447 • Orthopedics | $1,296 | $1,296 | $1,296 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $592 | $592 | $592 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $918 | $918 | $919 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,084 | $1,084 | $1,084 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $572 | $572 | $572 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $551 | $551 | $552 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $991 | $991 | $991 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,019 | $1,019 | $1,019 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,154 | $1,154 | $1,154 |
| Carpal tunnel release CPT 64721 • Orthopedics | $475 | $475 | $475 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $13 | $13 | $13 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $284 | $284 | $284 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,574 | $2,574 | $2,574 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $53 | $53 | $53 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $271 | $271 | $271 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $190 | $190 | $190 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $98 | $98 | $98 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $161 | $161 | $161 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $487 | $487 | $488 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $270 | $270 | $270 |
| Cytopathology concentration technique CPT 88108 • Pathology | $39 | $39 | $39 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $40 | $40 | $40 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $10 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $16 | $16 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $20 | $20 |