| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $50 | $60 | $70 |
| Fundus photography CPT 92250 • Ophthalmology | $50 | $50 | $50 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $54 | $57 | $61 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $46 | $46 | $46 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $66 | $69 | $75 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,085 | $2,085 | $2,085 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $50 | $996 | $1,942 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,839 | $2,053 | $2,266 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,463 | $1,618 | $1,773 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,629 | $1,803 | $1,977 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $432 | $469 | $506 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $350 | $366 | $383 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $660 | $660 | $660 |
| Total hip replacement CPT 27130 • Orthopedics | $50 | $853 | $1,656 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $50 | $1,048 | $2,046 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $50 | $754 | $1,458 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,501 | $1,501 | $1,501 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,499 | $1,499 | $1,499 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $50 | $732 | $1,414 |
| Total knee replacement CPT 27447 • Orthopedics | $50 | $1,000 | $1,654 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $50 | $447 | $700 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $298 | $323 | $348 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $50 | $691 | $1,105 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $213 | $213 | $213 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $50 | $678 | $1,305 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $50 | $367 | $684 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $50 | $420 | $659 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $700 | $772 | $844 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $991 | $1,093 | $1,196 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $50 | $618 | $1,187 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $50 | $698 | $1,347 |
| Carpal tunnel release CPT 64721 • Orthopedics | $50 | $290 | $530 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $84 | $149 | $195 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $262 | $278 | $311 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $103 | $120 | $137 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $308 | $308 | $308 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $403 | $453 | $504 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $40 | $46 | $52 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $58 | $58 | $58 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $50 | $93 | $136 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $50 | $87 | $125 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $208 | $208 | $208 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $107 | $107 | $107 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $150 | $150 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $269 | $356 | $443 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $12 | $109 | $206 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $14 | $14 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $41 | $41 | $41 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |