| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $57 | $57 | $57 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $28,516 | $28,516 | $28,516 |
| Total hip replacement CPT 27130 • Orthopedics | $25,000 | $25,000 | $25,000 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $57 | $57 | $57 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $57 | $57 | $57 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $57 | $57 | $57 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $57 | $57 | $57 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $15,000 | $15,000 | $15,000 |
| Total knee replacement CPT 27447 • Orthopedics | $33,500 | $33,500 | $33,500 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $45,983 | $45,983 | $45,983 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $19,682 | $19,682 | $19,682 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $45,983 | $45,983 | $45,983 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $45,983 | $45,983 | $45,983 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $42,765 | $42,765 | $42,765 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $33,816 | $33,816 | $33,816 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $33,816 | $33,816 | $33,816 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $45,983 | $45,983 | $45,983 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $45,983 | $45,983 | $45,983 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30,000 | $30,000 | $30,000 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $25,000 | $25,000 | $25,000 |
| Carpal tunnel release CPT 64721 • Orthopedics | $28,516 | $28,516 | $28,516 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $15,000 | $15,000 | $15,000 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $57 | $57 | $57 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $57 | $57 | $57 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $57 | $57 | $57 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $28,516 | $28,516 | $28,516 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $45 | $3,057 | $15,000 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $57 | $57 | $57 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $32,000 | $32,000 | $32,000 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $19,682 | $19,682 | $19,682 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $30,000 | $30,000 | $30,000 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $740 | $740 | $740 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $57 | $57 | $57 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $40,000 | $40,000 | $40,000 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $57 | $57 | $57 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $57 | $57 | $57 |
| Cytopathology concentration technique CPT 88108 • Pathology | $53 | $53 | $53 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $55 | $55 | $55 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $18 | $18 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $23 | $23 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $18 | $18 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $26 | $26 | $26 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $34 | $34 | $34 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $32 | $50 | $59 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $234 | $234 | $234 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $356 | $356 | $356 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $93 | $93 | $93 |
| Special stain group II CPT 88313 • Pathology | $66 | $66 | $66 |