| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $250 | $250 | $250 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $297 | $439 | $581 |
| Total hip replacement CPT 27130 • Orthopedics | $878 | $1,211 | $1,500 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,756 | $1,756 | $1,756 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,227 | $1,227 | $1,227 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,209 | $1,209 | $1,209 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $30 | $755 | $1,480 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,169 | $1,169 | $1,169 |
| Total knee replacement CPT 27447 • Orthopedics | $1,253 | $1,342 | $1,610 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $568 | $577 | $586 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $310 | $310 | $310 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $375 | $579 | $783 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $299 | $698 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,045 | $1,092 | $1,139 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $550 | $629 | $708 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $529 | $562 | $660 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $713 | $713 | $713 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $956 | $992 | $1,029 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $970 | $970 | $970 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,112 | $1,112 | $1,112 |
| Carpal tunnel release CPT 64721 • Orthopedics | $427 | $431 | $433 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $72 | $117 | $159 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $26 | $164 | $302 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $190 | $190 | $190 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $254 | $275 | $296 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $449 | $449 | $449 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $91 | $108 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $52 | $59 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $242 | $270 | $327 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $110 | $135 | $159 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $111 | $150 | $170 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $50 | $82 | $100 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $159 | $159 | $159 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $295 | $366 | $437 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $234 | $237 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $20 | $20 | $20 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $23 | $23 | $23 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $19 | $19 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $17 | $17 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $13 | $19 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $18 | $36 | $54 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $38 | $128 | $219 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $64 | $64 | $64 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $13 | $13 | $13 |
| Special stain group II CPT 88313 • Pathology | $27 | $39 | $52 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $28 | $54 | $79 |