| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,895 | $1,895 | $1,895 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,488 | $1,488 | $1,488 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,659 | $1,659 | $1,659 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $432 | $432 | $432 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $350 | $350 | $350 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $613 | $613 | $613 |
| Total hip replacement CPT 27130 • Orthopedics | $1,321 | $1,321 | $1,321 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,716 | $1,716 | $1,716 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,227 | $1,227 | $1,227 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,262 | $1,262 | $1,262 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,261 | $1,261 | $1,261 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,186 | $1,186 | $1,186 |
| Total knee replacement CPT 27447 • Orthopedics | $1,319 | $1,319 | $1,319 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $595 | $595 | $595 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $327 | $327 | $327 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $942 | $942 | $942 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $177 | $177 | $177 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,100 | $1,100 | $1,100 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $580 | $580 | $580 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $560 | $560 | $560 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $712 | $712 | $712 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,006 | $1,006 | $1,006 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,001 | $1,001 | $1,001 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,133 | $1,133 | $1,133 |
| Carpal tunnel release CPT 64721 • Orthopedics | $456 | $456 | $456 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $171 | $171 | $171 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $279 | $279 | $279 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $149 | $149 | $149 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $275 | $275 | $275 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,335 | $2,335 | $2,335 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $80 | $80 | $80 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $49 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $257 | $257 | $257 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $115 | $115 | $115 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $184 | $184 | $184 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $94 | $94 | $94 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $157 | $157 | $157 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $435 | $435 | $435 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $181 | $181 | $181 |
| Cytopathology concentration technique CPT 88108 • Pathology | $42 | $42 | $42 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $44 | $44 | $44 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $10 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $17 | $17 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $22 | $22 | $22 |
| 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 | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $47 | $47 | $47 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $192 | $192 | $192 |