| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $181 | $181 | $181 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $86 | $86 | $86 |
| Visual field examination CPT 92083 • Ophthalmology | $35 | $35 | $35 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $40 | $40 | $40 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $47 | $47 | $47 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $40 | $40 | $40 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $73 | $73 | $73 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,931 | $1,931 | $1,931 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,053 | $2,053 | $2,053 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $375 | $375 | $375 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $335 | $335 | $335 |
| Total hip replacement CPT 27130 • Orthopedics | $1,466 | $1,466 | $1,466 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,905 | $1,905 | $1,905 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,362 | $1,362 | $1,362 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,401 | $1,401 | $1,401 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,310 | $1,310 | $1,310 |
| Total knee replacement CPT 27447 • Orthopedics | $1,465 | $1,465 | $1,465 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $663 | $663 | $664 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $333 | $333 | $333 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $999 | $999 | $1,000 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,223 | $1,223 | $1,223 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $644 | $644 | $644 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $620 | $620 | $621 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $790 | $790 | $790 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,116 | $1,116 | $1,116 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,063 | $1,063 | $1,063 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,289 | $1,289 | $1,289 |
| Carpal tunnel release CPT 64721 • Orthopedics | $521 | $521 | $521 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $184 | $184 | $184 |
| 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 | $94 | $94 | $94 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $298 | $298 | $298 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $87 | $87 | $87 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $58 | $58 | $58 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $284 | $284 | $284 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $204 | $204 | $204 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $105 | $105 | $105 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $178 | $178 | $178 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $511 | $511 | $511 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $278 | $278 | $278 |
| Cytopathology concentration technique CPT 88108 • Pathology | $109 | $109 | $109 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $194 | $194 | $194 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $37 | $37 | $37 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $25 | $25 | $25 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $62 | $62 | $62 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $34 | $34 | $34 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $44 | $44 | $44 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $71 | $71 | $71 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $94 | $94 | $94 |