| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $192 | $192 | $192 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,021 | $1,021 | $1,021 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $470 | $470 | $471 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $483 | $483 | $483 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $213 | $266 | $319 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $558 | $558 | $558 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $750 | $750 | $750 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $109 | $109 | $109 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $79 | $79 | $79 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $90 | $90 | $90 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $116 | $116 | $116 |
| Visual field examination CPT 92083 • Ophthalmology | $32 | $32 | $32 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $13 | $13 | $13 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $50 | $50 | $50 |
| Fundus photography CPT 92250 • Ophthalmology | $19 | $19 | $19 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $56 | $56 | $57 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,473 | $1,473 | $1,473 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,384 | $1,384 | $1,384 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,608 | $1,608 | $1,608 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $520 | $520 | $520 |
| Total hip replacement CPT 27130 • Orthopedics | $1,139 | $1,139 | $1,139 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,480 | $1,480 | $1,480 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,057 | $1,057 | $1,057 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,023 | $1,023 | $1,023 |
| Total knee replacement CPT 27447 • Orthopedics | $1,137 | $1,137 | $1,138 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $512 | $512 | $512 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $813 | $813 | $814 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $948 | $948 | $948 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $498 | $498 | $498 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $481 | $481 | $481 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $882 | $882 | $882 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,000 | $1,000 | $1,000 |
| Carpal tunnel release CPT 64721 • Orthopedics | $407 | $407 | $407 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $148 | $148 | $148 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $246 | $246 | $246 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $72 | $72 | $72 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $45 | $45 | $45 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $230 | $230 | $230 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $165 | $165 | $165 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $85 | $85 | $85 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $138 | $138 | $138 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $391 | $391 | $392 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $161 | $161 | $162 |
| Cytopathology concentration technique CPT 88108 • Pathology | $43 | $43 | $43 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $46 | $46 | $46 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $19 | $19 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $16 | $16 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |