| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $425 | $425 | $425 |
| Total hip replacement CPT 27130 • Orthopedics | $2,229 | $2,229 | $2,229 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $2,595 | $2,595 | $2,595 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,772 | $1,772 | $1,772 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,811 | $1,811 | $1,811 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $2,268 | $2,268 | $2,268 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,804 | $1,804 | $1,804 |
| Total knee replacement CPT 27447 • Orthopedics | $2,406 | $2,406 | $2,406 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $868 | $868 | $868 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $467 | $467 | $467 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $962 | $962 | $962 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $1,090 | $1,090 | $1,090 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,783 | $1,783 | $1,783 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,045 | $1,045 | $1,045 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $968 | $968 | $968 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,049 | $1,049 | $1,049 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,600 | $1,600 | $1,600 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,396 | $1,396 | $1,396 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,661 | $1,661 | $1,661 |
| Carpal tunnel release CPT 64721 • Orthopedics | $625 | $625 | $625 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $113 | $113 | $113 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $194 | $194 | $194 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $267 | $267 | $267 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $416 | $416 | $416 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $644 | $644 | $644 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $161 | $161 | $161 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $83 | $83 | $83 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $596 | $596 | $596 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $111 | $111 | $111 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $273 | $273 | $273 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $90 | $90 | $90 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $249 | $249 | $249 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $788 | $788 | $788 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $329 | $329 | $329 |
| Cytopathology concentration technique CPT 88108 • Pathology | $32 | $32 | $32 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $26 | $26 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $7 | $7 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $18 | $18 | $18 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $13 | $13 | $13 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $48 | $48 | $48 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $44 | $44 | $44 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $122 | $122 | $122 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $23 | $23 | $23 |
| Special stain group II CPT 88313 • Pathology | $18 | $22 | $27 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $11 | $11 | $11 |
| Frozen section pathology each additional CPT 88332 • Pathology | $4 | $4 | $4 |