| Consultation office high complexity CPT 99245 • Office Visits | $200 | $201 | $201 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $580 | $580 | $580 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $36 | $36 | $36 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,092 | $1,092 | $1,092 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,013 | $1,013 | $1,013 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $468 | $470 | $472 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $85 | $85 | $85 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $478 | $478 | $478 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $315 | $315 | $316 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $422 | $422 | $422 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $733 | $733 | $733 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $80 | $80 | $80 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $23 | $23 | $23 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $44 | $44 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $20 | $20 | $20 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $41 | $50 | $59 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,478 | $1,478 | $1,478 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,395 | $1,395 | $1,395 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,585 | $1,585 | $1,585 |
| Total hip replacement CPT 27130 • Orthopedics | $1,159 | $1,159 | $1,159 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,506 | $1,506 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,080 | $1,080 | $1,080 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,110 | $1,110 | $1,110 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,038 | $1,038 | $1,038 |
| Total knee replacement CPT 27447 • Orthopedics | $1,158 | $1,159 | $1,161 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $530 | $537 | $544 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $810 | $817 | $823 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $971 | $971 | $971 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $514 | $514 | $514 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $496 | $498 | $499 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $804 | $804 | $804 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $971 | $971 | $971 |
| Carpal tunnel release CPT 64721 • Orthopedics | $409 | $409 | $409 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $151 | $151 | $151 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $128 | $128 | $128 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $240 | $240 | $240 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $46 | $46 | $46 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $229 | $229 | $229 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $163 | $163 | $163 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $84 | $84 | $84 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $134 | $134 | $134 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $408 | $410 | $412 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $54 | $136 | $219 |
| Cytopathology concentration technique CPT 88108 • Pathology | $40 | $40 | $40 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $41 | $41 | $41 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $17 | $17 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $19 | $19 |