| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $73 | $73 | $73 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,931 | $1,931 | $1,931 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $30 | $30 | $30 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,800 | $1,927 | $2,053 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,839 | $1,839 | $1,839 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $447 | $483 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $306 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $30 | $30 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $30 | $30 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $30 | $30 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $30 | $30 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $347 | $664 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $30 | $30 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $325 | $621 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $30 | $30 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $30 | $30 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $30 | $30 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $281 | $303 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $298 | $298 | $299 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $30 | $30 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $52 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $58 | $58 | $59 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $30 | $30 | $30 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $204 | $204 | $204 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $97 | $105 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $178 | $178 | $178 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $511 | $511 | $511 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $278 | $278 | $278 |
| Cytopathology concentration technique CPT 88108 • Pathology | $48 | $48 | $48 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $51 | $51 | $51 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $13 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $4 | $12 | $20 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $31 | $31 | $31 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $210 | $210 | $211 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $319 | $319 | $319 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $86 | $86 | $86 |
| Special stain group II CPT 88313 • Pathology | $59 | $60 | $61 |