| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,040 | $1,040 | $1,040 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $759 | $759 | $759 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $158 | $158 | $158 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $473 | $473 | $473 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $638 | $638 | $638 |
| Excision chalazion single CPT 67800 • Ophthalmology | $181 | $181 | $181 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $200 | $200 | $200 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $72 | $72 | $72 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $126 | $126 | $126 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $75 | $75 | $75 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $106 | $106 | $106 |
| Visual field examination CPT 92083 • Ophthalmology | $53 | $53 | $53 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $34 | $34 | $34 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $42 | $42 | $42 |
| Fundus photography CPT 92250 • Ophthalmology | $31 | $31 | $31 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $76 | $76 | $76 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $77 | $77 | $77 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $92 | $92 | $92 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $2,261 | $2,261 | $2,261 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,228 | $1,228 | $1,228 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,317 | $1,317 | $1,317 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,590 | $1,590 | $1,590 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $229 | $229 | $229 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $361 | $361 | $361 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $355 | $355 | $355 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $3,034 | $3,034 | $3,034 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $70 | $70 | $70 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $340 | $340 | $340 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $153 | $153 | $153 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $248 | $248 | $248 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $127 | $127 | $127 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $216 | $216 | $216 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $605 | $605 | $605 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $324 | $324 | $324 |
| Cytopathology concentration technique CPT 88108 • Pathology | $50 | $50 | $50 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $52 | $52 | $52 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $17 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $20 | $20 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $16 | $16 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $32 | $32 | $32 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $55 | $55 | $55 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $223 | $223 | $223 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $338 | $338 | $338 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $88 | $88 | $88 |
| Special stain group II CPT 88313 • Pathology | $63 | $63 | $63 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $79 | $79 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $42 | $42 |