| Fundus photography CPT 92250 • Ophthalmology | $44 | $44 | $44 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $44 | $51 | $59 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $69 | $69 | $69 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,724 | $1,724 | $1,724 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,800 | $1,839 | $1,879 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,673 | $1,673 | $1,673 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $451 | $451 | $451 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $31 | $31 | $31 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,243 | $1,243 | $1,243 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,278 | $1,278 | $1,278 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,199 | $1,199 | $1,199 |
| Total knee replacement CPT 27447 • Orthopedics | $1,331 | $1,331 | $1,331 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $615 | $615 | $615 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $344 | $344 | $344 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $974 | $974 | $974 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $44 | $110 | $177 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,118 | $1,118 | $1,118 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $573 | $573 | $573 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $725 | $725 | $725 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,022 | $1,022 | $1,022 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $895 | $895 | $895 |
| Carpal tunnel release CPT 64721 • Orthopedics | $425 | $425 | $425 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $179 | $179 | $179 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $263 | $263 | $263 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $260 | $260 | $260 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,386 | $2,386 | $2,386 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $74 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $47 | $47 | $48 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $111 | $111 | $111 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $172 | $172 | $172 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $88 | $88 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $143 | $143 | $143 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $444 | $444 | $444 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $249 | $249 | $249 |
| Cytopathology concentration technique CPT 88108 • Pathology | $38 | $44 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $39 | $39 | $39 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $14 | $14 | $15 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $31 | $31 | $31 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $169 | $169 | $170 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $257 | $257 | $257 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $86 | $86 | $86 |
| Special stain group II CPT 88313 • Pathology | $48 | $55 | $61 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $30 | $45 | $60 |
| Frozen section pathology each additional CPT 88332 • Pathology | $31 | $31 | $31 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $52 | $60 | $67 |