| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,142 | $1,142 | $1,142 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $495 | $495 | $495 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $327 | $327 | $327 |
| Excision chalazion single CPT 67800 • Ophthalmology | $62 | $62 | $62 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $772 | $772 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $122 | $122 | $122 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $39 | $39 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $48 | $48 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $7 | $7 | $7 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $40 | $40 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $63 | $63 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $87 | $87 | $87 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,166 | $1,166 | $1,166 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $240 | $240 | $240 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,128 | $1,128 | $1,128 |
| Total knee replacement CPT 27447 • Orthopedics | $1,253 | $1,253 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $568 | $568 | $568 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $309 | $309 | $309 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $865 | $865 | $865 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $169 | $169 | $169 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,046 | $1,046 | $1,046 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $530 | $530 | $530 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $674 | $674 | $674 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $956 | $956 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $949 | $949 | $949 |
| Carpal tunnel release CPT 64721 • Orthopedics | $433 | $433 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $159 | $159 | $159 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $258 | $258 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $255 | $255 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,288 | $2,288 | $2,288 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $31 | $31 | $31 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $49 | $49 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $110 | $110 | $110 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $89 | $89 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $150 | $150 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $437 | $437 | $437 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $240 | $240 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $49 | $49 | $49 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $219 | $219 | $219 |
| Special stain group II CPT 88313 • Pathology | $62 | $62 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $79 | $79 | $79 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $68 | $68 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $77 | $77 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $93 | $93 | $93 |