| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,024 | $2,024 | $2,024 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $263 | $263 | $263 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,149 | $2,149 | $2,149 |
| Total shoulder replacement CPT 23472 • Orthopedics | $203 | $203 | $203 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,847 | $2,847 | $2,847 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $637 | $637 | $637 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $214 | $214 | $214 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $353 | $353 | $353 |
| Total hip replacement CPT 27130 • Orthopedics | $1,518 | $1,518 | $1,518 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,056 | $1,056 | $1,056 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $168 | $168 | $168 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $204 | $204 | $204 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,851 | $1,851 | $1,851 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $162 | $162 | $162 |
| Total knee replacement CPT 27447 • Orthopedics | $206 | $206 | $206 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $437 | $437 | $437 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $189 | $189 | $189 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $385 | $385 | $385 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $27 | $27 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $203 | $203 | $203 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $673 | $673 | $673 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $973 | $973 | $973 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $517 | $517 | $517 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $619 | $619 | $619 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $153 | $153 | $153 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $211 | $211 | $211 |
| Carpal tunnel release CPT 64721 • Orthopedics | $525 | $525 | $525 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $124 | $124 | $124 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $189 | $189 | $189 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $93 | $93 | $93 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $116 | $116 | $116 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $415 | $415 | $415 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $74 | $74 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $33 | $33 | $33 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $166 | $166 | $166 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $51 | $51 | $51 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $135 | $135 | $135 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $50 | $50 | $50 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $145 | $145 | $145 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $226 | $226 | $226 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $87 | $87 | $87 |
| Cytopathology concentration technique CPT 88108 • Pathology | $20 | $20 | $20 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $41 | $41 | $41 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $6 | $6 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $15 | $15 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $14 | $14 |
| 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 | $40 | $40 | $40 |