| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $120 | $120 | $120 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $3,572 | $3,572 | $3,572 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $3,282 | $3,282 | $3,282 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $3,860 | $3,860 | $3,860 |
| Total shoulder replacement CPT 23472 • Orthopedics | $2,916 | $2,916 | $2,916 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $3,257 | $3,257 | $3,257 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $807 | $807 | $807 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $638 | $638 | $638 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $563 | $563 | $563 |
| Total hip replacement CPT 27130 • Orthopedics | $2,732 | $2,732 | $2,732 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $3,376 | $3,376 | $3,376 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $2,397 | $2,397 | $2,397 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $2,469 | $2,469 | $2,469 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $2,465 | $2,465 | $2,465 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $2,330 | $2,330 | $2,330 |
| Total knee replacement CPT 27447 • Orthopedics | $2,728 | $2,728 | $2,728 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $1,138 | $1,138 | $1,138 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $558 | $558 | $558 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $990 | $990 | $990 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $354 | $354 | $354 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $2,140 | $2,140 | $2,140 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,114 | $1,114 | $1,114 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $1,073 | $1,073 | $1,073 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,379 | $1,379 | $1,379 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,961 | $1,961 | $1,961 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $2,011 | $2,011 | $2,011 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $2,285 | $2,285 | $2,285 |
| Carpal tunnel release CPT 64721 • Orthopedics | $856 | $856 | $856 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $303 | $303 | $303 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $483 | $483 | $483 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $282 | $282 | $282 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $193 | $193 | $193 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $3,525 | $3,525 | $3,525 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $84 | $84 | $84 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $92 | $92 | $92 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $442 | $442 | $442 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $195 | $195 | $195 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $172 | $172 | $172 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $167 | $167 | $167 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $308 | $308 | $308 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $427 | $427 | $427 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $116 | $116 | $116 |
| Cytopathology concentration technique CPT 88108 • Pathology | $27 | $27 | $27 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $29 | $29 | $29 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $6 | $6 |
| 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 | $14 | $14 | $14 |