| Visual field examination CPT 92083 • Ophthalmology | $60 | $60 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $37 | $37 | $38 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $50 | $50 | $50 |
| Fundus photography CPT 92250 • Ophthalmology | $36 | $36 | $36 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $32 | $32 | $32 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $48 | $48 | $48 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $52 | $60 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,608 | $1,608 | $1,608 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,433 | $1,433 | $1,433 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $375 | $394 | $412 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $521 | $521 | $521 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,057 | $1,057 | $1,057 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,088 | $1,088 | $1,088 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,023 | $1,023 | $1,023 |
| Total knee replacement CPT 27447 • Orthopedics | $1,138 | $1,195 | $1,253 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $512 | $512 | $512 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $280 | $280 | $280 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $814 | $814 | $814 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $154 | $154 | $154 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $949 | $949 | $949 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $481 | $505 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $613 | $613 | $613 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $868 | $868 | $868 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $882 | $882 | $882 |
| Carpal tunnel release CPT 64721 • Orthopedics | $407 | $420 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $148 | $148 | $148 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $250 | $250 | $250 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $246 | $246 | $246 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,064 | $2,064 | $2,064 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $39 | $56 | $72 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $46 | $47 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $242 | $242 | $242 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $104 | $104 | $104 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $170 | $170 | $170 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $85 | $87 | $88 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $137 | $137 | $138 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $392 | $392 | $392 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $161 | $161 | $162 |
| Cytopathology concentration technique CPT 88108 • Pathology | $44 | $44 | $44 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $20 | $20 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $16 | $16 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $198 | $198 | $198 |
| Special stain group II CPT 88313 • Pathology | $55 | $55 | $55 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $73 | $76 | $79 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $64 | $64 | $64 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $73 | $73 | $73 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $86 | $89 | $92 |