| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $32 | $32 | $32 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $29 | $44 | $60 |
| Fundus photography CPT 92250 • Ophthalmology | $29 | $56 | $82 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $53 | $58 | $62 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $55 | $55 | $55 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $66 | $90 | $129 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $1,079 | $1,893 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,769 | $1,769 | $1,769 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,047 | $2,047 | $2,047 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,633 | $1,633 | $1,633 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,821 | $1,821 | $1,821 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $487 | $487 | $487 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $358 | $358 | $358 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $340 | $340 | $340 |
| Total hip replacement CPT 27130 • Orthopedics | $1,519 | $1,519 | $1,519 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,877 | $1,877 | $1,877 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,336 | $1,336 | $1,336 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,373 | $1,373 | $1,373 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,374 | $1,374 | $1,374 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,298 | $1,298 | $1,298 |
| Total knee replacement CPT 27447 • Orthopedics | $1,519 | $1,519 | $1,519 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $637 | $637 | $637 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $316 | $316 | $316 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $590 | $590 | $590 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $198 | $198 | $198 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,198 | $1,198 | $1,198 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $626 | $626 | $626 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $602 | $602 | $602 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $779 | $779 | $779 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,103 | $1,103 | $1,103 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $141 | $607 | $1,072 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,220 | $1,220 | $1,220 |
| Carpal tunnel release CPT 64721 • Orthopedics | $438 | $454 | $470 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $96 | $127 | $157 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $125 | $125 | $125 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $173 | $173 | $173 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $114 | $114 | $114 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $473 | $473 | $473 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $88 | $88 | $88 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $41 | $41 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $129 | $180 | $232 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $60 | $82 | $103 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $193 | $209 | $225 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $97 | $112 | $126 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $157 | $157 | $157 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $473 | $473 | $473 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $69 | $69 | $69 |
| Cytopathology concentration technique CPT 88108 • Pathology | $26 | $26 | $26 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $28 | $30 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $18 | $21 |