| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $209 | $209 | $209 |
| Visual field examination CPT 92083 • Ophthalmology | $108 | $108 | $108 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $76 | $76 | $76 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $226 | $226 | $226 |
| Fundus photography CPT 92250 • Ophthalmology | $33 | $33 | $33 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $122 | $122 | $122 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $85 | $85 | $85 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $102 | $102 | $102 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,851 | $1,851 | $1,851 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $439 | $439 | $439 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $513 | $513 | $513 |
| Total shoulder replacement CPT 23472 • Orthopedics | $402 | $402 | $402 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $935 | $935 | $935 |
| Total hip replacement CPT 27130 • Orthopedics | $375 | $375 | $375 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $2,892 | $2,892 | $2,892 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $2,000 | $2,000 | $2,000 |
| Total knee replacement CPT 27447 • Orthopedics | $2,340 | $2,340 | $2,340 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $1,498 | $1,498 | $1,498 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,817 | $1,817 | $1,817 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $929 | $929 | $929 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $602 | $602 | $602 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,696 | $1,696 | $1,696 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $305 | $305 | $305 |
| Carpal tunnel release CPT 64721 • Orthopedics | $732 | $732 | $732 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $272 | $272 | $272 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $456 | $456 | $456 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $449 | $449 | $449 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,232 | $2,232 | $2,232 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $136 | $136 | $136 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $790 | $790 | $790 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $149 | $149 | $149 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $438 | $438 | $438 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $148 | $148 | $148 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $247 | $247 | $247 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $701 | $701 | $701 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $287 | $287 | $287 |
| Cytopathology concentration technique CPT 88108 • Pathology | $40 | $86 | $109 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $49 | $122 | $194 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $37 | $37 | $37 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $25 | $25 | $25 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $62 | $62 | $62 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $34 | $34 | $34 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $44 | $49 | $54 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $12 | $41 | $71 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $20 | $57 | $94 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $87 | $93 | $98 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $169 | $216 | $295 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $260 | $337 | $413 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $87 | $126 |
| Special stain group II CPT 88313 • Pathology | $21 | $67 | $90 |