| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,354 | $1,354 | $1,354 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,593 | $1,593 | $1,593 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,291 | $1,291 | $1,291 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $247 | $247 | $247 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $498 | $498 | $498 |
| Total hip replacement CPT 27130 • Orthopedics | $1,243 | $1,243 | $1,243 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,029 | $1,029 | $1,029 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,059 | $1,059 | $1,059 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,071 | $1,071 | $1,071 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $956 | $956 | $956 |
| Total knee replacement CPT 27447 • Orthopedics | $1,329 | $1,329 | $1,329 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $494 | $494 | $494 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $269 | $269 | $269 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $625 | $625 | $625 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $576 | $576 | $576 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $932 | $932 | $932 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $595 | $595 | $595 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $557 | $557 | $557 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $601 | $601 | $601 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $854 | $854 | $854 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $817 | $817 | $817 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $929 | $929 | $929 |
| Carpal tunnel release CPT 64721 • Orthopedics | $368 | $368 | $368 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $44 | $44 | $44 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $299 | $299 | $299 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $144 | $144 | $144 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $227 | $227 | $227 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $366 | $366 | $366 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $118 | $118 | $118 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $43 | $43 | $43 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $615 | $615 | $615 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $209 | $209 | $209 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $159 | $159 | $159 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $79 | $79 | $79 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $123 | $123 | $123 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $524 | $524 | $524 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $219 | $219 | $219 |
| Cytopathology concentration technique CPT 88108 • Pathology | $66 | $66 | $66 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $89 | $89 | $89 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $25 | $25 | $25 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $31 | $31 | $31 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $17 | $17 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $47 | $47 | $47 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $55 | $55 | $55 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $93 | $93 | $93 |