| Colorectal | 45380 | Colonoscopy with Biopsy | $1,610.00 |
| Colorectal | 46200 | Fissurectomy | $3,256.00 |
| Colorectal | 46260 | Hemorroidectomy | $3,256.00 |
| ENT | 42830 | Adenoidectomy | $2,915.00 |
| ENT | 69436 | Adenoidectomy/Tympanostomy with Tube Insertion | $3,432.00 |
| ENT | 69436 | Bilateral Myringotomy and Tubes | $2,090.00 |
| ENT | 21555 | Excision of mass | $3,536.00 |
| ENT | 30520 | Septoplasty (Simple) | $3,476.00 |
| ENT | 42826 | Tonsillectomy | $3,465.00 |
| ENT | 42821 | Tonsillectomy/Adenoidectomy | $3,630.00 |
| Gastro | 45380 | Colonoscopy with Biopsy | $1,610.00 |
| Gastro | 43239 | EGD with Biopsy | $1,310.00 |
| Gastro | 43235, 45378 | EGD with Colonoscopy | $2,210.00 |
| General | 46270 | Anal Fistula | $3,476.00 |
| General | null | Excision of mass | $3,536.00 |
| General | 46260 | Hemorroidectomy | $3,256.00 |
| General | 49572 | Hernia Repair, Epigastric | $4,950.00 |
| General | 49650 | Hernia Repair, Inguinal | $4,950.00 |
| General | 49650 | Hernia Repair, Inguinal Bilateral | $6,000.00 |
| General | 79652 | Hernia Repair, Laparoscopic | $5,500.00 |
| General | 49587 | Hernia Repair, Ventricular/Umbilical | $4,400.00 |
| General | 44960, 44970 | Laparoscopic Appendectomy | $5,670.00 |
| General | 47562 | Laparoscopic Cholecystectomy | $5,670.00 |
| General | 11770–11772 | Pilonidal Cyst | $4,026.00 |
| General | 36568 | Port Placement | $3,630.00 |
| General | 36590 | Port Removal | $2,090.00 |
| General | 60240 | Thyroidectomy, Total | $6,336.00 |
| GYN | 49320 | Diagnostic Laparoscopy | $4,900.00 |
| GYN | 58120 | Dilation & Curettage | $2,816.00 |
| GYN | 58563 | Hysterectomy, Laparoscopic | $10,000.00 |
| GYN | null | Hysteroscopy, Novasure | $4,400.00 |
| GYN | 58671 | Tubal Ligation | $3,630.00 |
| GYN | 58750 | Tubal Reversal, Open | $5,500.00 |
| Ortho | 27650 | Achilles tendon repair | $6,798.00 |
| Ortho | 29888 | Anterior Cruciate Ligament Repair/Reconstruction w/ graft | $14,135.00 |
| Ortho | 29888 | Anterior Cruciate Ligament Repair/Reconstruction without graft | $9,735.00 |
| Ortho | 64721 | Carpel Tunnel Release Open vs Endo | $3,905.00 |
| Ortho | 25608 | Closed Reduction/Casting | $2,640.00 |
| Ortho | 27766 | Complex Fracture Repair, Plates/Screws | $7,095.00 |
| Ortho | 26040, 26045 | Dupuytrens Contracture Release | $3,685.00 |
| Ortho | 27630 | Excision Ganglion cyst | $3,564.00 |
| Ortho | 64774, 64784 | Excision of neuroma | $3,641.00 |
| Ortho | 29882 | Knee Arthroscopy | $4,939.00 |
| Ortho | 23700 | Manipulation under anesthesia | $2,145.00 |
| Ortho | 23455 | Shoulder Arthroscopy (Labral repair) | $7,568.00 |
| Ortho | 29827 | Shoulder Arthroscopy Rotator Cuff Repair (arthroscopic) | $7,568.00 |
| Ortho | 29822, 29826 | Shoulder Arthroscopy(Subacromial decompression)(Distal clavicle resection) | $7,568.00 |
| Ortho | 26605 | Simple Fracture Repair, Perc Pinning | $4,785.00 |
| Ortho | 27447 | Total Knee Arthroplasty | $17,435.00 |
| Ortho | 26055 | Trigger Finger release | $3,575.00 |
| Ortho | 29845 | Wrist Arthroscopy | $4,565.00 |
| Pain Mgt | 64530 | Celiac Plexus Nerve Block | $1,166.00 |
| Pain Mgt | 62321, 62323 | Epidural Steriod Injection (Thoracic, Lumbar) | $1,210.00 |
| Pain Mgt | 64490, 64495 | Facet Joint Injection (Cervical/Lumbar) 1 Level | $1,331.00 |
| Pain Mgt | 64490, 64495 | Facet Joint Injection (Cervical/Lumbar) 2 Level | $1,452.00 |
| Pain Mgt | 64490, 64495 | Facet Joint Injection (Cervical/Lumbar) 3 Level | $1,463.00 |
| Pain Mgt | 64633 | Facet Joint RFA | $1,870.00 |
| Pain Mgt | 64633 | Facet Joint RFA Bilateral | $1,980.00 |
| Pain Mgt | 64520 | Lumbar Sympathetic Nerve Block | $1,166.00 |
| Pain Mgt | 64405 | Occipital nerve block for headache | $660.00 |
| Pain Mgt | 64640 | SI Joint | $1,166.00 |
| Pain Mgt | 64640 | SI Joint RFA | $1,980.00 |
| Pain Mgt | 29873 | Steroid injection knee | $572.00 |
| Pain Mgt | 64400 | Supraorbital nerve block | $660.00 |
| Pain Mgt | 20552 | Trigger Point Injection | $660.00 |
| Plastic | 15847 | Abdominoplasty | $11,770.00 |
| Plastic | 15822 | Blepharoplasty Upper and Lower | $2,750.00 |
| Plastic | 15822 | Blepharoplasty Upper or Lower | $2,419.00 |
| Plastic | 19325 | Breast Augmentation (Hybrid) | $7,479.00 |
| Plastic | 19325 | Breast Augmentation (Saline) | $5,499.00 |
| Plastic | 19325 | Breast Augmentation (Silicone) | $6,599.00 |
| Plastic | 30420 | Rhinoplasty | $11,000.00 |
| Podiatry | 28292 | Bunionectomy | $4,510.00 |
| Podiatry | 28080 | Excision of neuroma | $3,641.00 |
| Podiatry | 28118 | Haglunds | $3,630.00 |
| Podiatry | 28285 | Hammertoe (1) | $2,970.00 |
| Podiatry | 28285 | Hammertoe (2) | $3,520.00 |
| Podiatry | 28285 | Hammertoe (3) | $4,070.00 |
| Podiatry | 28008 | Instep / Fasciotomy | $2,750.00 |
| Podiatry | 28113 | Osteotomy | $3,520.00 |
| Podiatry | 0232T | Platelet-Rich Plasma Injection | $2,255.00 |
| Podiatry | 28820 | Toe Amputation | $3,146.00 |
| Spine | 63075 | ACDF 1 level | $19,800.00 |
| Spine | 63075 | ACDF 2 level | $27,456.00 |
| Spine | 36355 | Laminectomy Lumbar 1 level | $10,670.00 |
| Spine | null | Lumbar Fusion 1 level | $38,500.00 |
| Spine | null | Lumbar Fusion 2 level | $52,250.00 |
| Spine | 63030 | Microdisectomy 1 level | $17,387.00 |
| Spine | 22869 | Superion Indirect Decompression System | $13,860.00 |
| Urology | 54161 | Circumcision | $2,750.00 |
| Urology | 52010 | Cystoscopy | $3,520.00 |
| Urology | 52353 | Cystoscopy with Lithotripsy | $4,466.00 |
| Urology | 50590 | ESWL (Lithotripsy Extracorporeal Shockwave) | $6,072.00 |
| Urology | 54520 | Orchiectomy | $4,026.00 |
| Urology | null | Ureteroscopy | $3,520.00 |
| Urology | null | Vasectomy | $2,750.00 |
