| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $76 | $76 | $76 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $102 | $104 | $105 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,545 | $1,545 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $581 | $581 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $3,055 | $3,055 | $3,055 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,631 | $1,631 | $1,631 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,166 | $1,166 | $1,166 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,127 | $1,127 | $1,127 |
| Total knee replacement CPT 27447 • Orthopedics | $3,267 | $3,267 | $3,267 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $299 | $568 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $265 | $500 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $2,269 | $2,269 | $2,269 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,427 | $1,427 | $1,427 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $280 | $529 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $674 | $674 | $674 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $956 | $956 | $956 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $948 | $948 | $948 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,075 | $1,075 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $102 | $102 | $102 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $352 | $352 | $352 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $400 | $541 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $530 | $530 | $530 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $852 | $852 | $852 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $93 | $93 | $93 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $527 | $527 | $527 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $343 | $343 | $343 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $177 | $177 | $177 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $265 | $265 | $265 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $959 | $959 | $959 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $240 | $320 | $400 |
| Cytopathology concentration technique CPT 88108 • Pathology | $53 | $53 | $53 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $86 | $86 | $86 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $18 | $18 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $36 | $36 | $36 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $46 | $46 | $46 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $49 | $49 | $49 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $147 | $183 | $219 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $220 | $220 | $220 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $66 | $66 | $66 |
| Special stain group II CPT 88313 • Pathology | $48 | $48 | $48 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $79 | $79 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $31 | $31 | $31 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $45 | $45 | $45 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $70 | $70 | $70 |