| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,457 | $1,457 | $1,457 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $352 | $352 | $352 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $415 | $415 | $415 |
| Total hip replacement CPT 27130 • Orthopedics | $1,193 | $1,193 | $1,193 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,396 | $1,396 | $1,396 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $981 | $981 | $981 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,009 | $1,009 | $1,009 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $914 | $914 | $914 |
| Total knee replacement CPT 27447 • Orthopedics | $1,276 | $1,276 | $1,276 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $458 | $458 | $459 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $237 | $237 | $237 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $545 | $545 | $545 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $541 | $541 | $541 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $886 | $886 | $886 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $557 | $557 | $557 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $520 | $520 | $520 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $563 | $563 | $563 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $811 | $811 | $811 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $803 | $803 | $803 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $917 | $917 | $917 |
| Carpal tunnel release CPT 64721 • Orthopedics | $333 | $333 | $333 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $40 | $89 | $138 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $211 | $211 | $211 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $206 | $206 | $207 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $333 | $333 | $333 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $80 | $80 | $80 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $40 | $40 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $205 | $205 | $205 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $105 | $105 | $106 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $134 | $134 | $134 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $69 | $69 | $69 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $130 | $130 | $130 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $374 | $374 | $375 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $156 | $156 | $156 |
| Cytopathology concentration technique CPT 88108 • Pathology | $44 | $44 | $44 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $62 | $62 | $62 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $17 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $23 | $23 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $37 | $37 | $37 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $129 | $129 | $129 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $197 | $197 | $197 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $60 | $60 | $60 |
| Special stain group II CPT 88313 • Pathology | $44 | $44 | $44 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $55 | $55 | $55 |
| Frozen section pathology each additional CPT 88332 • Pathology | $24 | $24 | $24 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $42 | $42 | $43 |