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| CPT CODE | Full Price | Cash Price |
| 10021 | $210.00 | $157.50 |
| 10060 | $180.00 | $150.00 |
| 10061 | $285.00 | $265.00 |
| 10120 | $210.00 | $180.00 |
| 10121 | $400.00 | $300.00 |
| 10160 | $175.00 | $131.25 |
| 11000 | $110.00 | $80.00 |
| 11042 | $145.00 | $108.75 |
| 11055 | $75.00 | $60.00 |
| 11056 | $100.00 | $75.00 |
| 11104 | $145.00 | $130.00 |
| 11105 | $50.00 | $40.00 |
| 11200 | $135.00 | $110.00 |
| 11201 | $40.00 | $25.00 |
| 11300 | $95.00 | $71.25 |
| 11301 | $125.00 | $93.75 |
| 11302 | $176.00 | $132.00 |
| 11303 | $230.00 | $200.00 |
| 11305 | $100.00 | $75.00 |
| 11306 | $135.00 | $101.25 |
| 11307 | $175.00 | $30.00 |
| 11310 | $115.00 | $86.25 |
| 11311 | $170.00 | $127.50 |
| 11312 | $200.00 | $150.00 |
| 11400 | $185.00 | $138.75 |
| 11401 | $215.00 | $161.25 |
| 11402 | $255.00 | $200.00 |
| 11403 | $280.00 | $210.00 |
| 11404 | $350.00 | $300.00 |
| 11406 | $490.00 | $367.50 |
| 11420 | $185.00 | $138.75 |
| 11421 | $350.00 | $262.50 |
| 11422 | $280.00 | $210.00 |
| 11423 | $310.00 | $232.50 |
| 11424 | $400.00 | $350.00 |
| 11440 | $215.00 | $161.25 |
| 11441 | $250.00 | $187.50 |
| 11442 | $280.00 | $210.00 |
| 11600 | $300.00 | $250.00 |
| 11601 | $280.00 | $210.00 |
| 11602 | $330.00 | $275.00 |
| 11603 | $400.00 | $350.00 |
| 11604 | $500.00 | $425.00 |
| 11620 | $325.00 | $250.00 |
| 11621 | $425.00 | $350.00 |
| 11622 | $425.00 | $350.00 |
| 11640 | $350.00 | $275.00 |
| 11641 | $375.00 | $300.00 |
| 11642 | $475.00 | $400.00 |
| 11719 | $35.00 | $25.00 |
| 11720 | $50.00 | $37.50 |
| 11721 | $75.00 | $60.00 |
| 11730 | $175.00 | $150.00 |
| 11740 | $65.00 | $65.00 |
| 11750 | $300.00 | $230.00 |
| 11765 | $220.00 | $200.00 |
| 11900 | $125.00 | $93.75 |
| 12001 | $235.00 | $176.25 |
| 12002 | $255.00 | $191.25 |
| 12011 | $245.00 | $183.75 |
| 12013 | $280.00 | $210.00 |
| 12031 | $415.00 | $311.25 |
| 12032 | $340.00 | $255.00 |
| 12041 | $320.00 | $240.00 |
| 16000 | $115.00 | $95.00 |
| 16020 | $130.00 | $115.00 |
| 17000 | $100.00 | $85.00 |
| 17003 | $25.00 | $15.00 |
| 17110 | $175.00 | $140.00 |
| 17111 | $200.00 | $160.00 |
| 17250 | $150.00 | $120.00 |
| 17260 | $140.00 | $105.00 |
| 17261 | $240.00 | $200.00 |
| 20550 | $160.00 | $120.00 |
| 20552 | $100.00 | $80.00 |
| 20605 | $100.00 | $80.00 |
| 20610 | $110.00 | $90.00 |
| 21930 | $650.00 | $600.00 |
| 29105 | $135.00 | $101.25 |
| 29125 | $105.00 | $85.00 |
| 29131 | $80.00 | $70.00 |
| 29505 | $245.00 | $183.75 |
| 29515 | $125.00 | $93.75 |
| 29550 | $60.00 | $50.00 |
| 30300 | $325.00 | $300.00 |
| 36415 | $10.00 | $5.00 |
| 36416 | $10.00 | $5.00 |
| 54056 | $245.00 | $200.00 |
| 54150 | $350.00 | $325.00 |
| 55250 | $800.00 | $750.00 |
| 58301 | $150.00 | $112.50 |
| 64405 | $180.00 | $150.00 |
| 64505 | $150.00 | $130.00 |
| 65205 | $100.00 | $75.00 |
| 69200 | $195.00 | $170.00 |
| 69209 | $35.00 | $20.00 |
| 69210 | $95.00 | $70.00 |
| 81000 | $10.00 | $5.00 |
| 81025 | $15.00 | $10.00 |
| 82044 | $10.00 | $5.00 |
| 82272 | $10.00 | $5.00 |
| 82570 | $10.00 | $10.00 |
| 82962 | $5.00 | $5.00 |
| 83036 | $20.00 | $15.00 |
| 86308 | $15.00 | $10.00 |
| 86403 | $25.00 | $20.00 |
| 86580 | $15.00 | $15.00 |
| 87420 | $25.00 | $20.00 |
| 87426 | $75.00 | $45.00 |
| 87428 | $100.00 | $75.00 |
| 87804 | $35.00 | $20.00 |
| 87880 | $35.00 | $20.00 |
| 90460 | $40.00 | $30.00 |
| 90461 | $20.00 | $15.00 |
| 90471 | $40.00 | $30.00 |
| 90472 | $20.00 | $15.00 |
| 90473 | $40.00 | $30.00 |
| 90632 | $135.00 | $130.00 |
| 90633 | $65.00 | $60.00 |
| 90648 | $55.00 | $30.00 |
| 90651 | $325.00 | $300.00 |
| 90660 | $50.00 | $50.00 |
| 90662 | $70.00 | $55.00 |
| 90670 | $225.00 | $165.00 |
| 90680 | $140.00 | $105.00 |
| 90685 | $30.00 | $30.00 |
| 90686 | $20.00 | $15.00 |
| 90688 | $30.00 | $30.00 |
| 90691 | $100.00 | $75.00 |
| 90698 | $140.00 | $130.00 |
| 90700 | $50.00 | $45.00 |
| 90707 | $120.00 | $105.00 |
| 90710 | $220.00 | $165.00 |
| 90713 | $65.00 | $55.00 |
| 90714 | $75.00 | $50.00 |
| 90715 | $75.00 | $60.00 |
| 90716 | $200.00 | $115.00 |
| 90723 | $125.00 | $100.00 |
| 90732 | $130.00 | $125.00 |
| 90734 | $160.00 | $160.00 |
| 90736 | $220.00 | $165.00 |
| 90744 | $65.00 | $50.00 |
| 90746 | $135.00 | $75.00 |
| 90750 | $250.00 | $225.00 |
| 92532 | $45.00 | $35.00 |
| 92551 | $30.00 | $20.00 |
| 92567 | $40.00 | $30.00 |
| 93000 | $50.00 | $35.00 |
| 93015 | $160.00 | $120.00 |
| 93306 | $325.00 | $243.75 |
| 94150 | $30.00 | $22.50 |
| 94620 | $125.00 | $93.75 |
| 94621 | $250.00 | $187.50 |
| 94640 | $40.00 | $30.00 |
| 94760 | $10.00 | $7.50 |
| 96110 | $12.00 | $10.00 |
| 96127 | $10.00 | $5.00 |
| 96360 | $100.00 | $75.00 |
| 96369 | $250.00 | $235.00 |
| 96372 | $40.00 | $30.00 |
| 97602 | $55.00 | $45.00 |
| 98925 | $55.00 | $40.00 |
| 99050 | $40.00 | $50.00 |
| 99058 | $50.00 | $40.00 |
| 99173 | $20.00 | $10.00 |
| 99201 | $75.00 | $50.00 |
| 99202 | $150.00 | $115.00 |
| 99203 | $190.00 | $150.00 |
| 99204 | $275.00 | $200.00 |
| 99205 | $325.00 | $250.00 |
| 99211 | $50.00 | $40.00 |
| 99212 | $100.00 | $75.00 |
| 99213 | $150.00 | $115.00 |
| 99214 | $180.00 | $135.00 |
| 99215 | $250.00 | $185.00 |
| 99354 | $175.00 | $150.00 |
| 99355 | $185.00 | $150.00 |
| 99381 | $170.00 | $130.00 |
| 99382 | $185.00 | $135.00 |
| 99383 | $180.00 | $140.00 |
| 99384 | $200.00 | $155.00 |
| 99385 | $195.00 | $155.00 |
| 99386 | $205.00 | $180.00 |
| 99387 | $220.00 | $185.00 |
| 99391 | $130.00 | $115.00 |
| 99392 | $135.00 | $125.00 |
| 99393 | $135.00 | $125.00 |
| 99394 | $150.00 | $135.00 |
| 99395 | $155.00 | $140.00 |
| 99396 | $165.00 | $150.00 |
| 99397 | $175.00 | $160.00 |
| 99401 | $65.00 | $50.00 |
| 99406 | $25.00 | $20.00 |
| 99408 | $55.00 | $40.00 |
| 99495 | $225.00 | $200.00 |
| 99496 | $255.00 | $240.00 |
| 99497 | $130.00 | $100.00 |
| A4466 | $30.00 | $25.00 |
| A4467 | $25.00 | $20.00 |
| A4550 | $25.00 | $10.00 |
| A4565 | $15.00 | $10.00 |
| A4570 | $20.00 | $15.00 |
| A6442 | $15.00 | $10.00 |
| G0008 | $30.00 | $15.00 |
| G0009 | $30.00 | $15.00 |
| G0010 | $40.00 | $15.00 |
| G0103 | $100.00 | $75.00 |
| G0180 | $85.00 | $63.75 |
| G0402 | $175.00 | $150.00 |
| G0436 | $20.00 | $15.00 |
| G0437 | $30.00 | $20.00 |
| G0438 | $175.00 | $150.00 |
| G0439 | $125.00 | $120.00 |
| G0444 | $30.00 | $5.00 |
| J0696 | $5.00 | $5.00 |
| J1050 | $5.00 | $5.00 |
| J1885 | $5.00 | $5.00 |
| J2550 | $5.00 | $5.00 |
| J2930 | $20.00 | $15.00 |
| J3301 | $10.00 | $5.00 |
| J3420 | $5.00 | $5.00 |
| J3475 | $10.00 | $5.00 |
| J7030 | $10.00 | $7.50 |
| J7322 | $550.00 | $412.50 |
| J7506 | $1.00 | $1.00 |
| J7510 | $1.00 | $1.00 |
| J7613 | $5.00 | $5.00 |
| J7614 | $10.00 | $5.00 |
| J8540 | $5.00 | $5.00 |
| L1902 | $105.00 | $60.00 |
| L3650 | $75.00 | $50.00 |
| L3908 | $60.00 | $45.00 |
| L3923 | $65.00 | $50.00 |
| L4350 | $90.00 | $50.00 |
| L4386 | $175.00 | $150.00 |
| L4398 | $80.00 | $65.00 |
| Q2038 | $70.00 | $40.00 |
