| Colorectal | 45378 | Colonoscopy w/biopsy | $1,706 |
| Colorectal | 46257 | Fissurectomy | $3,921 |
| Colorectal | 46221 | Hemorroidectomy | $3,921 |
| Colorectal | 46275 45378 | Fissurectomy & Colonoscopy | $2,403 |
| Ear, Nose and Throat | 42830 | Adenoidectomy | $3,335 |
| Ear, Nose and Throat | 31256, 31276, 31287, 30115 | B-Maxillary Antrostomy, B-Frontal Sinus, B- Sphenoidotomy, Extensive Nasal Polyp Removal | $8,837 |
| Ear, Nose and Throat | 21320 | Closed reduction Nasal Fracture | $2,475 |
| Ear, Nose and Throat | 21030-21049 | Excision Mass | $3,921 |
| Ear, Nose and Throat | 40819 | Frenectomy | $1,945 |
| Ear, Nose and Throat | 69421 | Myringotomy w/ tubes, Bilateral | $2,805 |
| Ear, Nose and Throat | 69421/31231 | Myringotomy w/ tubes, Bilateral & Nasal Endoscopy | $2,750 |
| Ear, Nose and Throat | 30520 | Septoplasty (Simple) | $5,071 |
| Ear, Nose and Throat | 30520 | Septoplasty & Bilateral Turbinate | $5,646 |
| Ear, Nose and Throat | 42825 | Tonsillectomy | $4,726 |
| Ear, Nose and Throat | 42820 | Tonsillectomy & Adenoidectomy | $4,841 |
| Ear, Nose and Throat | 42820, 30140, 31231 | Tonsils/Adenoids, Bilateral Turbinectomy, Direct Nasal Endoscopy | $7,946 |
| Ear, Nose and Throat | 69631 | Tympanoplasty w/graft | $6,037 |
| Ear, Nose and Throat | 69436 | Tympanostomy w/ tube insertion & Adenoidectomy | $3,875 |
| Gastroenterology | 45380 | Colonoscopy w/biopsy | $1,706 |
| Gastroenterology | 43239 | Esophagogastroduodenoscopy w/biopsy | $1,369 |
| Gastroenterology | 45378, 43235 | Esophagogastroduodenoscopy w/Colonoscopy | $2,369 |
| Gastroenterology | 45330 | Sigmoidoscopy | $1,706 |
| General | 46270 | Anal Fistula - Fistulectomy/ Fistulotomy, subcutaneous | $3,921 |
| General | 21501 | Excision of Mass | $3,921 |
| General | 46260 | Hemorroidectomy | $3,921 |
| General | 49652 | Hernia Repair Laparoscopic | $6,037 |
| General | 49650 | Hernia Repair, Inguinal | $5,187 |
| General | 49650 | Hernia Repair, Inguinal Bilateral | $6,273 |
| General | 49587 | Hernia Repair, Ventral/Umbilical | $4,675 |
| General | 44960, 44970 | Laparoscopic Appendectomy | $6,215 |
| General | 47562 | Laparoscopic Cholecystectomy | $6,215 |
| General | 19303 | Mastectomy, Bilateral | $8,061 |
| General | 19305-19306 | Mastectomy, Radical | $8,061 |
| General | 19301-19303 | Mastectomy, Simple Complete | $5,416 |
| General | 19303 | Mastectomy, Single | $5,416 |
| General | 11770, 11771, 11772 | Pilonidal Cyst | $4,496 |
| General | 36568 | Port Placement | $3,507 |
| General | 36590 | Port Removal | $2,587 |
| General | 60240 | Thyroidectomy, Total | $7,486 |
| General | 55250 | Vasectomy | $3,162 |
| Gynecology | 58661 | Diagnostic Laparoscopy | $5,175 |
| Gynecology | 58120 | Dilation & Curettage | $3,091 |
| Gynecology | 58558 | Dilation & Curettage, Hysteroscopy | $3,795 |
| Gynecology | 58563 | Endometrial Ablation | $5,225 |
| Gynecology | 58563 | Hysterectomy, Laparoscopic | $10,000 |
| Gynecology | 58150 | Hysterectomy, open | $11,506 |
| Gynecology | 56620 | Labiaplasty | $3,696 |
| Gynecology | 58661 | Laparoscopic Bilateral Salpingectomy | $5,071 |
| Gynecology | 58145 | Myomectomy | $6,941 |
| Gynecology | 58260 | Total Vaginal Hysterectomy, anterior & posterior repair, and perineal repair | $12,086 |
| Gynecology | 58671 | Tubal Ligation | $3,905 |
| Gynecology | 58750 | Tubal Reversal, Open | $5,775 |
| Gynecology | 58260 | Vaginal Hysterectomy | $8,646 |
| Gynecology | 57550 | Vaginal Removal of Cervical Stump | $5,012 |
| Orthopedic | 27650 | Achilles tendon repair | $7,403 |
| Orthopedic | 29888 | Anterior Cruciate Ligament Repair/Reconstruction without graft | $10,340 |
| Orthopedic | 29888 | Anthroscopic Cruciate Ligament Repair/Reconstruction w/ graft | $14,740 |
| Orthopedic | 64721/64718 | Carpel Tunnel Release & Cubital Tunnel Release | $7,750 |
| Orthopedic | 29848 | Carpel Tunnel Release Open vs Endo | $4,180 |
| Orthopedic | 25565 | Closed Reduction/Casting | $3,135 |
| Orthopedic | 26540 | CMC Arthroplasty-Repair of collateral ligament, metacarpophalangeal or interphalangeal joint | $3,905 |
| Orthopedic | 28525 | Complex Fracture Repair, Plates/Screws (ORIF) | $7,700 |
| Orthopedic | 26040 | Dupuytrens Contracture Release | $3,960 |
| Orthopedic | 26160 | Excision Ganglion cyst | $3,839 |
| Orthopedic | 28080 | Excision of neuroma | $3,916 |
| Orthopedic | 22915 | Hip Arthroscopy | $10,982 |
| Orthopedic | 29866 | Knee Arthroscopy | $6,380 |
| Orthopedic | | Knee Arthroscopy - Bilateral | $5,390 |
| Orthopedic | 29882/ 29883 | Knee Arthroscopy w/meniscal repair | $8,030 |
| Orthopedic | 23700 | Manipulation under anesthesia | $2,050 |
| Orthopedic | 29916 | Shoulder Arthroscopy (Labral repair) | $10,557 |
| Orthopedic | 23410 | Shoulder Arthroscopy Rotator Cuff Repair (arthroscopic) | $11,403 |
| Orthopedic | 29824 | Shoulder Arthroscopy(Subacromial decompression)(Distal clavicle) | $9,622 |
| Orthopedic | 26608 | Simple Fracture Repair, Percutaneous Pinning | $5,060 |
| Orthopedic | 27130 | Total Hip Arthroplasty | $20,130 |
| Orthopedic | 27445 | Total Knee Arthroplasty | $20,000 |
| Orthopedic | | Total Knee Arthroplasty - Bilateral | $29,727 |
| Orthopedic | 23472 | Total Shoulder Replacement | $26,015 |
| Orthopedic | 26055 | Trigger Finger release | $3,850 |
| Orthopedic | 29843 | Wrist Arthroscopy | $4,840 |
| Pain | 64530 | Celiac Plexus Nerve Block | $1,219 |
| Pain | 62321, 62323 | Epidural Steriod Injection (Cervical) | $1,380 |
| Pain | 62321, 62323 | Epidural Steriod Injection (Thoracic, Lumbar, Caudal) | $1,265 |
| Pain | 64633 | Facet Joint Radiofrequency Ablation | $1,955 |
| Pain | 64633 x 2 | Facet Joint Radiofrequency Ablation, Bilateral | $2,047 |
| Pain | 66454 | Genicular Nerve Block | $1,495 |
| Pain | 64624 | Genicular Radiofrequency Ablation | $2,817 |
| Pain | 64520 | Lumbar Sympathetic Nerve Block | $1,219 |
| Pain | 64490, 64493 | Medial Branch Block (Cervical/Lumbar) 1 Level | $1,391 |
| Pain | 64490, 64491, 64493, 64494 | Medial Branch Block (Cervical/Lumbar) 2 Level | $1,518 |
| Pain | 64490, 64491, 64493, 64494, 64495 | Medial Branch Block (Cervical/Lumbar) 3 Level | $1,529 |
| Pain | 64405 | Occipital Nerve Block for headaches | $690 |
| Pain | 27096 | Sacroiliac Joint Injection | $1,219 |
| Pain | 64625 | Sacroiliac Joint Radiofrequency Ablation | $2,047 |
| Pain | 63688 | Spinal Cord Stimulator Explant | $3,875 |
| Pain | 64510 | Stellate Ganglion Nerve Block | $1,219 |
| Pain | 20610 | Steroid Injection Knee-w/o Ultrasound Guidance 1 Side | $598 |
| Pain | 22869 | Superion Indirect Decompression System | $14,490 |
| Pain | 64483 | Transforaminal Epidural Steroid Injection | $1,265 |
| Pain | 20552 | Trigger Point Injection | $660 |
| Plastic | | 1 hour | $4,427 |
| Plastic | | 1.5 hours | $5,347 |
| Plastic | | 2 hours | $6,497 |
| Plastic | | 2.5 hours | $7,417 |
| Plastic | | 3 hours | $9,487 |
| Plastic | | Gynocomastia | Call for pricing |
| Podiatry | 28292 | Bunionectomy | $5,002 |
| Podiatry | 64774, 64784 | Excision of neuroma | $4,094 |
| Podiatry | 28118 | Haglunds Deformity | $4,082 |
| Podiatry | 28285 | Hammertoe x 1 | $3,392 |
| Podiatry | 28285 | Hammertoe x 2 | $3,967 |
| Podiatry | 28285 | Hammertoe x 3 | $4,542 |
| Podiatry | 28008 | Instep/ Fasciotomy | $3,162 |
| Podiatry | 28113 | Osteotomy | $3,967 |
| Podiatry | 0232T | Plasma-rich plasma injection | $2,875 |
| Podiatry | 28820 | Toe amputation | $3,576 |
| Podiatry | 27687 | Gastrocnemius Resection | $3,852 |
| Podiatry | 28297 | Cotton Osteotomy-Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method | $8,682 |
| Podiatry | 29891 | Ankle Arthroscopy-excision of osteochondral defect of talus and/or tibia, including drilling of the defect | $2,587 |
| Podiatry | 28060 | Endoscopic Plantar Fascia Release | $7,228 |
| Podiatry | 28119 | Heel Spur Excision | $2,587 |
| Podiatry | 28297 | Lapidus Bunionectomy | $11,212 |
| Spine | 63075 | Anterior Cervical discectomy and fusion | $30,475 |
| Spine | 63075 | Anterior Cervical discectomy and fusion | $40,089 |
| Spine | 49215 | Excision of Coccyx Mass | $3,922 |
| Spine | 63047 | Laminectomy, Lumbar 1 Level | $14,030 |
| Spine | 63030 | Microdiscectomy 1 Level | $18,176 |
| Urology | 54161 | Circumcision | $3,162 |
| Urology | 52356 | Cysto w/lithotripsy | $5,232 |
| Urology | 52010 | Cystoscopy | $3,967 |
| Urology | 52356, C1776 | ESWL (Lithotripsy Extracorporeal Shockwave) | $6,635 |
| Urology | 54530 | Orchiectomy | $4,496 |
| Urology | 53854 | Rezum System-includes cystoscopy | Call for Pricing |
| Urology | 55110 | Scrotal Exploration | Call for Pricing |
| Urology | 52601 | Transurethral Electrosurgical resection of Prostate | $5,900 |
| Urology | 53252 | Ureteroscopy | $3,967 |
| Urology | 51715 | Urethral Bulking | $3,601 |
| Urology | 52442 | Urolift-each additional implant | Call for Pricing |
| Urology | 52441 | Urolift-initial system-includes cystoscopy | $8,721 |
| Urology | 52441/53854 | Urolift/Rezum/Cystoscopy | $8,721 |
| Urology | 55250 | Vasectomy | $3,162 |
| Urology | 55250 | Vericocele Single | $3,358 |
