| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $8 | $17 | $26 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $13 | $28 | $43 |
| Fundus photography CPT 92250 • Ophthalmology | $11 | $22 | $34 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $45 | $45 | $45 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $64 | $64 | $64 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $55 | $60 | $65 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,221 | $2,221 | $2,221 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,734 | $1,734 | $1,734 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,394 | $2,394 | $2,394 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,674 | $1,674 | $1,674 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,133 | $2,133 | $2,133 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $473 | $473 | $473 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $301 | $301 | $301 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $312 | $312 | $312 |
| Total hip replacement CPT 27130 • Orthopedics | $1,592 | $1,592 | $1,592 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,868 | $1,868 | $1,868 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,298 | $1,298 | $1,298 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,287 | $1,287 | $1,287 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,580 | $1,580 | $1,580 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,249 | $1,249 | $1,249 |
| Total knee replacement CPT 27447 • Orthopedics | $1,713 | $1,713 | $1,713 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $622 | $622 | $622 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $328 | $328 | $328 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $805 | $805 | $805 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $747 | $747 | $747 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,219 | $1,219 | $1,219 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $752 | $752 | $752 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $700 | $700 | $700 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $756 | $756 | $756 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,101 | $1,101 | $1,101 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,016 | $1,016 | $1,016 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,173 | $1,173 | $1,173 |
| Carpal tunnel release CPT 64721 • Orthopedics | $455 | $495 | $535 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $76 | $102 | $127 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $142 | $201 | $260 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $114 | $114 | $114 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $130 | $194 | $257 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $474 | $474 | $474 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $112 | $112 | $112 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $61 | $61 | $61 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $120 | $185 | $250 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $111 | $148 | $184 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $201 | $235 | $269 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $66 | $101 | $136 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $123 | $153 | $183 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $306 | $481 | $657 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $236 | $239 | $242 |
| Cytopathology concentration technique CPT 88108 • Pathology | $19 | $19 | $19 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $25 | $25 | $25 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |