| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,627 | $1,627 | $1,627 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,001 | $2,001 | $2,001 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,555 | $1,555 | $1,555 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,767 | $1,767 | $1,767 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $449 | $449 | $449 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $281 | $281 | $281 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $575 | $575 | $575 |
| Total hip replacement CPT 27130 • Orthopedics | $1,491 | $1,491 | $1,491 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,741 | $1,741 | $1,741 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,222 | $1,222 | $1,222 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,257 | $1,257 | $1,257 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,314 | $1,314 | $1,314 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,156 | $1,156 | $1,156 |
| Total knee replacement CPT 27447 • Orthopedics | $1,598 | $1,598 | $1,598 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $579 | $579 | $579 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $306 | $306 | $306 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $736 | $736 | $736 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $688 | $688 | $688 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,123 | $1,123 | $1,123 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $701 | $701 | $701 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $653 | $653 | $653 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $707 | $707 | $707 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,024 | $1,024 | $1,024 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $984 | $984 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,118 | $1,118 | $1,118 |
| Carpal tunnel release CPT 64721 • Orthopedics | $424 | $424 | $424 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $185 | $185 | $185 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $282 | $282 | $282 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $175 | $175 | $175 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $278 | $278 | $278 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $411 | $411 | $411 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $107 | $107 | $107 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $54 | $54 | $54 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $285 | $285 | $285 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $142 | $142 | $142 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $186 | $186 | $186 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $94 | $94 | $94 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $156 | $156 | $156 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $498 | $498 | $498 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $211 | $211 | $211 |
| Cytopathology concentration technique CPT 88108 • Pathology | $44 | $44 | $44 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $61 | $61 | $61 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $19 | $19 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $16 | $16 | $16 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $39 | $39 | $39 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $65 | $65 | $65 |