| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $58 | $58 | $58 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,329 | $1,329 | $1,329 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,215 | $1,215 | $1,215 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,407 | $1,407 | $1,407 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,075 | $1,075 | $1,075 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,189 | $1,189 | $1,189 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $322 | $322 | $322 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $331 | $331 | $331 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $244 | $244 | $244 |
| Total hip replacement CPT 27130 • Orthopedics | $961 | $961 | $961 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,242 | $1,242 | $1,242 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $904 | $904 | $904 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $929 | $929 | $929 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $927 | $927 | $927 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $868 | $868 | $868 |
| Total knee replacement CPT 27447 • Orthopedics | $958 | $958 | $958 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $474 | $474 | $474 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $299 | $299 | $299 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $754 | $754 | $754 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $120 | $120 | $120 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $810 | $810 | $810 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $446 | $446 | $446 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $432 | $432 | $432 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $535 | $535 | $535 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $738 | $738 | $738 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $751 | $751 | $751 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $887 | $887 | $887 |
| Carpal tunnel release CPT 64721 • Orthopedics | $357 | $357 | $357 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $151 | $151 | $151 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $238 | $238 | $238 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $124 | $124 | $124 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $73 | $73 | $73 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,087 | $2,087 | $2,087 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $32 | $32 | $32 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $24 | $24 | $24 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $228 | $228 | $228 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $101 | $101 | $101 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $67 | $67 | $67 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $82 | $82 | $82 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $90 | $90 | $90 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $400 | $400 | $400 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $219 | $219 | $219 |
| Cytopathology concentration technique CPT 88108 • Pathology | $23 | $23 | $23 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $11 | $11 | $11 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $9 | $9 | $9 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $15 | $15 | $15 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $16 | $16 | $16 |