| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $487 | $497 | $502 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $825 | $2,885 | $6,982 |
| Total hip replacement CPT 27130 • Orthopedics | $2,058 | $24,240 | $68,550 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $2,542 | $24,568 | $68,550 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,812 | $14,375 | $39,452 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,865 | $14,411 | $39,452 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,865 | $11,081 | $29,462 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,758 | $24,038 | $68,550 |
| Total knee replacement CPT 27447 • Orthopedics | $2,057 | $24,240 | $68,550 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $869 | $5,704 | $15,352 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $471 | $485 | $502 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,386 | $8,952 | $24,046 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $269 | $349 | $502 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,602 | $14,233 | $39,452 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $849 | $8,589 | $24,046 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $817 | $8,567 | $24,046 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,059 | $8,731 | $24,046 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,492 | $14,159 | $39,452 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,464 | $14,140 | $39,452 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,665 | $14,276 | $39,452 |
| Carpal tunnel release CPT 64721 • Orthopedics | $644 | $5,553 | $15,352 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $238 | $328 | $502 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $370 | $2,274 | $6,072 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $233 | $2,181 | $6,072 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $363 | $2,269 | $6,072 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,946 | $14,466 | $39,452 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $120 | $2,105 | $6,072 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $73 | $216 | $502 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $325 | $2,243 | $6,072 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $131 | $256 | $502 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $255 | $2,196 | $6,072 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $129 | $255 | $502 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $215 | $313 | $502 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $618 | $5,535 | $15,352 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $254 | $339 | $502 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $502 | $502 | $502 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $61 | $61 | $61 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $60 | $61 | $62 |
| 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 | $38 | $38 | $38 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $65 | $65 | $65 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $260 | $260 | $260 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $396 | $396 | $396 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $102 | $102 | $102 |
| Special stain group II CPT 88313 • Pathology | $73 | $73 | $73 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $94 | $94 | $94 |
| Frozen section pathology each additional CPT 88332 • Pathology | $50 | $50 | $50 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $80 | $80 | $80 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $92 | $92 | $92 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $110 | $110 | $110 |