| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $70 | $70 | $70 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $123 | $123 | $123 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $33 | $33 | $33 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $38 | $38 | $38 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $29 | $29 | $29 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $53 | $54 | $54 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,425 | $1,425 | $1,425 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,325 | $1,325 | $1,325 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,544 | $1,544 | $1,544 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,345 | $1,345 | $1,345 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $349 | $349 | $349 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $282 | $282 | $282 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $242 | $242 | $242 |
| Total hip replacement CPT 27130 • Orthopedics | $1,073 | $1,073 | $1,073 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,395 | $1,395 | $1,395 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $995 | $995 | $995 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $958 | $958 | $958 |
| Total knee replacement CPT 27447 • Orthopedics | $1,072 | $1,081 | $1,091 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $482 | $492 | $503 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $262 | $262 | $262 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $717 | $717 | $718 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $893 | $893 | $893 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $469 | $469 | $469 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $451 | $456 | $462 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $727 | $727 | $727 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $883 | $883 | $883 |
| Carpal tunnel release CPT 64721 • Orthopedics | $351 | $351 | $351 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $132 | $133 | $134 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $202 | $202 | $202 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $108 | $108 | $108 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $198 | $198 | $198 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $39 | $39 | $39 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $189 | $189 | $189 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $86 | $86 | $86 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $136 | $136 | $136 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $70 | $70 | $70 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $121 | $121 | $121 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $340 | $342 | $344 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $183 | $184 | $184 |
| Cytopathology concentration technique CPT 88108 • Pathology | $47 | $47 | $47 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $48 | $48 | $48 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $21 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $16 | $16 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $203 | $205 | $207 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $314 | $314 | $314 |