| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $2,510 | $2,510 | $2,510 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,800 | $1,800 | $1,801 |
| Total shoulder replacement CPT 23472 • Orthopedics | $2,423 | $2,423 | $2,423 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $306 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $2,305 | $2,305 | $2,305 |
| 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 | $615 | $1,200 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $2,288 | $2,288 | $2,288 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $919 | $1,808 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $1,255 | $2,480 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $30 | $30 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $253 | $475 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $598 | $1,166 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $556 | $1,081 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $897 | $1,764 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,089 | $1,089 | $1,089 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $1,014 | $1,014 | $1,014 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $562 | $1,094 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $30 | $30 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $751 | $1,472 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,698 | $1,698 | $1,698 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $345 | $659 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $55 | $80 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $105 | $182 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $137 | $137 | $137 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $255 | $255 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $30 | $30 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $11 | $11 | $11 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $49 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $556 | $556 | $556 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $171 | $171 | $171 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $89 | $89 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $150 | $150 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $437 | $437 | $437 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $240 | $240 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $49 | $49 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $51 | $51 | $51 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $40 | $40 | $40 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $66 | $66 | $66 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $5 | $5 |
| 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 | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $218 | $218 | $219 |