| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,440 | $1,440 | $1,440 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,626 | $1,626 | $1,626 |
| Total shoulder replacement CPT 23472 • Orthopedics | $41 | $41 | $41 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $414 | $414 | $414 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $543 | $543 | $543 |
| Total hip replacement CPT 27130 • Orthopedics | $2,025 | $2,025 | $2,025 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,537 | $1,537 | $1,537 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,608 | $1,608 | $1,608 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,123 | $1,123 | $1,123 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $2,065 | $2,065 | $2,065 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,014 | $1,014 | $1,014 |
| Total knee replacement CPT 27447 • Orthopedics | $2,182 | $2,182 | $2,182 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $526 | $526 | $526 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $461 | $461 | $461 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $667 | $667 | $667 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $988 | $988 | $988 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,601 | $1,601 | $1,601 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $945 | $945 | $945 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $876 | $876 | $876 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $943 | $943 | $943 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,452 | $1,452 | $1,452 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $41 | $91 | $141 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $992 | $992 | $992 |
| Carpal tunnel release CPT 64721 • Orthopedics | $438 | $467 | $496 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $41 | $99 | $157 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $103 | $103 | $103 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $238 | $238 | $238 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $41 | $41 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $89 | $89 | $89 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $46 | $46 | $46 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $41 | $137 | $232 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $41 | $72 | $103 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $171 | $198 | $225 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $85 | $105 | $126 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $126 | $126 | $126 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $418 | $418 | $418 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $178 | $178 | $178 |
| Cytopathology concentration technique CPT 88108 • Pathology | $50 | $50 | $50 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $63 | $100 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $21 | $21 | $21 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $45 | $45 | $45 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $54 | $54 | $54 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $10 | $10 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $35 | $70 | $106 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $103 | $164 | $226 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $339 | $339 | $339 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $108 | $108 | $108 |
| Special stain group II CPT 88313 • Pathology | $5 | $42 | $79 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $88 | $88 | $88 |
| Frozen section pathology each additional CPT 88332 • Pathology | $11 | $11 | $11 |