| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $26 | $26 | $26 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,280 | $1,280 | $1,280 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $789 | $789 | $789 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $734 | $734 | $734 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $798 | $798 | $798 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $26 | $26 | $26 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,142 | $1,142 | $1,142 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,294 | $1,294 | $1,294 |
| Carpal tunnel release CPT 64721 • Orthopedics | $464 | $464 | $464 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $26 | $26 | $26 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $26 | $26 | $26 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $115 | $115 | $115 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $60 | $60 | $60 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $287 | $287 | $287 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $26 | $26 | $26 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $107 | $107 | $107 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $116 | $116 | $116 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $115 | $115 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $126 | $126 | $126 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $126 | $126 | $126 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $148 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $161 | $161 | $161 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $61 | $61 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $72 | $72 | $72 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $99 | $99 | $99 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $109 | $109 | $109 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $109 | $109 | $109 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $120 | $120 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $134 | $134 | $134 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $347 | $347 | $347 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $377 | $377 | $377 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $26 | $26 | $26 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $381 | $381 | $381 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $455 | $455 | $455 |
| Laparoscopic partial nephrectomy CPT 50543 • Urology | $1,872 | $1,872 | $1,872 |
| Laparoscopic radical nephrectomy CPT 50545 • Urology | $1,697 | $1,697 | $1,697 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $703 | $703 | $703 |
| Complex uroflowmetry CPT 51741 • Urology | $26 | $26 | $26 |
| Post-void residual urine measurement CPT 51798 • Urology | $27 | $27 | $27 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $26 | $26 | $26 |
| Cystourethroscopy with tumor fulguration small CPT 52234 • Urology | $316 | $316 | $316 |
| Cystourethroscopy with tumor fulguration medium CPT 52235 • Urology | $370 | $370 | $370 |
| Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology | $267 | $267 | $267 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $571 | $571 | $571 |
| Cystourethroscopy with lithotripsy CPT 52353 • Urology | $544 | $544 | $544 |
| TURP transurethral resection of prostate CPT 52601 • Urology | $1,030 | $1,030 | $1,030 |
| Laser vaporization of prostate CPT 52648 • Urology | $2,616 | $2,616 | $2,616 |
| Circumcision CPT 54150 • Urology | $125 | $125 | $125 |
| Orchiectomy simple CPT 54520 • Urology | $410 | $410 | $410 |
| Orchiectomy radical inguinal CPT 54530 • Urology | $635 | $635 | $635 |