| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $647 | $647 | $648 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $939 | $939 | $939 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $686 | $686 | $686 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $144 | $144 | $144 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,491 | $1,491 | $1,491 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $657 | $657 | $657 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $431 | $431 | $432 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $576 | $576 | $576 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,039 | $1,039 | $1,039 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $190 | $190 | $190 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $42 | $42 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $50 | $50 | $50 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $21 | $21 | $21 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $59 | $59 | $59 |
| Fundus photography CPT 92250 • Ophthalmology | $47 | $47 | $47 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $57 | $57 | $57 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $68 | $68 | $68 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,776 | $1,776 | $1,776 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,649 | $1,649 | $1,649 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,884 | $1,884 | $1,884 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $648 | $648 | $648 |
| Total hip replacement CPT 27130 • Orthopedics | $1,328 | $1,328 | $1,328 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,725 | $1,725 | $1,725 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,238 | $1,238 | $1,238 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,190 | $1,190 | $1,190 |
| Total knee replacement CPT 27447 • Orthopedics | $1,327 | $1,327 | $1,328 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $611 | $611 | $611 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $936 | $936 | $937 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,113 | $1,113 | $1,113 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $593 | $593 | $593 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $571 | $571 | $571 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,015 | $1,015 | $1,015 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $952 | $952 | $952 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,149 | $1,149 | $1,149 |
| Carpal tunnel release CPT 64721 • Orthopedics | $468 | $468 | $468 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $83 | $128 | $173 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $274 | $274 | $274 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $50 | $50 | $50 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $260 | $260 | $260 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $185 | $185 | $185 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $94 | $94 | $94 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $161 | $161 | $161 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $468 | $468 | $468 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $260 | $260 | $260 |
| Cytopathology concentration technique CPT 88108 • Pathology | $59 | $59 | $59 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $59 | $59 | $59 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $19 | $19 | $19 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $29 | $29 | $29 |