| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $83 | $83 | $83 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $62 | $62 | $62 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $75 | $75 | $75 |
| Visual field examination CPT 92083 • Ophthalmology | $60 | $60 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $28 | $34 | $39 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $30 | $39 | $48 |
| Fundus photography CPT 92250 • Ophthalmology | $5 | $18 | $30 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $30 | $30 | $30 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $33 | $43 | $53 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $53 | $53 | $53 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $30 | $30 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,710 | $1,755 | $1,800 |
| Total shoulder replacement CPT 23472 • Orthopedics | $141 | $141 | $141 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,023 | $1,023 | $1,023 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $369 | $369 | $369 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $306 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $486 | $941 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $423 | $816 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $553 | $553 | $553 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $100 | $169 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $30 | $30 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $272 | $515 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $199 | $199 | $199 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $53 | $75 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $80 | $80 | $80 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $407 | $784 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $256 | $482 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $493 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $30 | $30 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $16 | $16 | $16 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $104 | $157 | $210 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $38 | $146 | $254 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $45 | $61 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $8 | $8 | $8 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $37 | $42 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $30 | $30 | $30 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $170 | $170 | $170 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $67 | $77 | $88 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $133 | $141 | $149 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $353 | $394 | $436 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $145 | $145 | $145 |
| Cytopathology concentration technique CPT 88108 • Pathology | $42 | $46 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $51 | $51 | $51 |