| Total shoulder replacement CPT 23472 • Orthopedics | $1,306 | $1,306 | $1,306 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,460 | $1,460 | $1,460 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $368 | $368 | $368 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $282 | $282 | $282 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $475 | $475 | $475 |
| Total hip replacement CPT 27130 • Orthopedics | $1,219 | $1,219 | $1,219 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,506 | $1,506 | $1,506 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,073 | $1,073 | $1,073 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,105 | $1,105 | $1,105 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,105 | $1,105 | $1,105 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,040 | $1,040 | $1,040 |
| Total knee replacement CPT 27447 • Orthopedics | $1,218 | $1,218 | $1,218 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $511 | $511 | $511 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $272 | $272 | $272 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $781 | $781 | $781 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $160 | $160 | $160 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $934 | $934 | $934 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $499 | $499 | $499 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $480 | $480 | $480 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $627 | $627 | $627 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $881 | $881 | $881 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $904 | $904 | $904 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,029 | $1,029 | $1,029 |
| Carpal tunnel release CPT 64721 • Orthopedics | $378 | $378 | $378 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $134 | $134 | $134 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $210 | $210 | $210 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $132 | $132 | $132 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $206 | $206 | $206 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,101 | $1,101 | $1,101 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $67 | $67 | $67 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $40 | $40 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $182 | $182 | $182 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $73 | $73 | $73 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $144 | $144 | $144 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $72 | $72 | $72 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $134 | $134 | $134 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $348 | $348 | $348 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $143 | $143 | $143 |
| Cytopathology concentration technique CPT 88108 • Pathology | $39 | $39 | $39 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $42 | $42 | $42 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $20 | $20 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $20 | $20 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $11 | $11 | $11 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $42 | $42 | $42 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $165 | $165 | $165 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $253 | $253 | $253 |