| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $231 | $231 | $231 |
| Total hip replacement CPT 27130 • Orthopedics | $634 | $634 | $634 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $741 | $741 | $741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $522 | $522 | $522 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $537 | $537 | $537 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $545 | $545 | $545 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $486 | $486 | $486 |
| Total knee replacement CPT 27447 • Orthopedics | $678 | $678 | $678 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $246 | $246 | $246 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $117 | $117 | $117 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $302 | $302 | $302 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $290 | $290 | $290 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $472 | $472 | $472 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $298 | $298 | $298 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $278 | $278 | $278 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $301 | $301 | $301 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $432 | $432 | $432 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $418 | $418 | $418 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $478 | $478 | $478 |
| Carpal tunnel release CPT 64721 • Orthopedics | $179 | $179 | $179 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $77 | $77 | $77 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $117 | $117 | $117 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $74 | $74 | $74 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $115 | $115 | $115 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $625 | $625 | $625 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $44 | $44 | $44 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $18 | $18 | $18 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $48 | $48 | $48 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $59 | $59 | $59 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $75 | $75 | $75 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $24 | $24 | $24 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $70 | $70 | $70 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $217 | $217 | $217 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $91 | $91 | $91 |
| Cytopathology concentration technique CPT 88108 • Pathology | $12 | $12 | $12 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $26 | $26 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $7 | $7 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $17 | $17 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $13 | $13 | $13 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $3 | $3 | $3 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $47 | $47 | $47 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $36 | $36 | $36 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $82 | $82 | $82 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $45 | $45 | $45 |
| Special stain group II CPT 88313 • Pathology | $28 | $28 | $28 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $27 | $27 |
| Frozen section pathology each additional CPT 88332 • Pathology | $5 | $5 | $5 |