| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Total hip replacement CPT 27130 • Orthopedics | $45 | $45 | $45 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $45 | $45 | $45 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $38 | $45 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $568 | $1,105 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $38 | $45 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $38 | $45 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $45 | $328 | $611 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $30 | $30 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $38 | $45 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $38 | $45 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $45 | $45 | $45 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $45 | $308 | $571 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $30 | $30 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $370 | $1,035 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $45 | $45 | $45 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $203 | $535 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $90 | $150 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $210 | $243 | $260 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $256 | $257 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $34 | $38 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $30 | $30 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $45 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $250 | $343 | $437 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $71 | $111 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $146 | $208 | $269 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $104 | $126 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $123 | $136 | $150 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $468 | $563 | $657 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $236 | $245 | $260 |
| Cytopathology concentration technique CPT 88108 • Pathology | $42 | $46 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $13 | $30 | $47 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $22 | $22 | $22 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $11 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $22 | $22 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $17 | $28 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $16 | $31 | $47 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $160 | $260 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $277 | $277 | $277 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $67 | $67 | $67 |
| Special stain group II CPT 88313 • Pathology | $5 | $38 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $79 | $79 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $37 | $37 | $37 |