| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $135 | $135 | $135 |
| Visual field examination CPT 92083 • Ophthalmology | $68 | $68 | $68 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $35 | $35 | $35 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $51 | $51 | $51 |
| Fundus photography CPT 92250 • Ophthalmology | $39 | $39 | $39 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $45 | $55 | $66 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $27 | $48 | $68 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $58 | $69 | $81 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,094 | $2,094 | $2,094 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,424 | $1,424 | $1,424 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,636 | $1,636 | $1,636 |
| Total shoulder replacement CPT 23472 • Orthopedics | $3,064 | $3,064 | $3,064 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $425 | $425 | $425 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $671 | $671 | $671 |
| Total hip replacement CPT 27130 • Orthopedics | $1,147 | $1,147 | $1,147 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $251 | $1,889 | $3,526 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $2,514 | $2,514 | $2,514 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $2,587 | $2,587 | $2,587 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,109 | $1,109 | $1,109 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,038 | $1,038 | $1,038 |
| Total knee replacement CPT 27447 • Orthopedics | $1,145 | $1,145 | $1,145 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $176 | $271 | $366 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $600 | $766 | $932 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $143 | $143 | $143 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $973 | $973 | $973 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $538 | $538 | $538 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $521 | $521 | $521 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $644 | $644 | $644 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $887 | $887 | $887 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $2,031 | $2,031 | $2,031 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,037 | $1,037 | $1,037 |
| Carpal tunnel release CPT 64721 • Orthopedics | $498 | $498 | $498 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $72 | $129 | $186 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $84 | $207 | $331 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $323 | $323 | $323 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $84 | $205 | $326 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $328 | $1,456 | $2,585 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $34 | $60 | $85 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $52 | $52 | $52 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $87 | $196 | $305 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $39 | $82 | $125 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $115 | $167 | $219 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $65 | $89 | $113 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $127 | $155 | $183 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $244 | $370 | $496 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $75 | $173 | $271 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $71 | $129 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $70 | $70 | $70 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $26 | $26 | $26 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $27 | $27 | $27 |