| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $143 | $143 | $143 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $85 | $85 | $85 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $71 | $71 | $71 |
| Visual field examination CPT 92083 • Ophthalmology | $25 | $25 | $25 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $23 | $23 | $23 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $56 | $72 | $87 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $33 | $58 | $83 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $57 | $63 | $69 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,608 | $1,743 | $1,878 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,503 | $1,503 | $1,503 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $528 | $528 | $528 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $313 | $379 | $445 |
| Total hip replacement CPT 27130 • Orthopedics | $1,794 | $1,794 | $1,794 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,730 | $1,730 | $1,730 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $44 | $44 | $44 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,277 | $1,502 | $1,727 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,743 | $1,743 | $1,743 |
| Total knee replacement CPT 27447 • Orthopedics | $1,138 | $1,541 | $1,944 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $512 | $512 | $512 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $814 | $814 | $814 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $258 | $258 | $258 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,624 | $1,624 | $1,624 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $481 | $656 | $831 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $44 | $549 | $1,054 |
| Carpal tunnel release CPT 64721 • Orthopedics | $653 | $653 | $653 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $148 | $163 | $179 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $101 | $101 | $101 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,385 | $2,385 | $2,385 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $39 | $52 | $65 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $79 | $79 | $79 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $549 | $549 | $549 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $44 | $114 | $183 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $238 | $238 | $238 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $392 | $392 | $392 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $161 | $161 | $162 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $41 | $41 | $41 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $198 | $198 | $198 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $23 | $23 | $23 |
| Microdissection manual CPT 88381 • Pathology | $138 | $138 | $138 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $7 | $7 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $12 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $8 | $8 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $17 | $29 | $41 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $20 | $33 | $47 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $18 | $18 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $16 | $27 | $39 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $10 | $10 |