| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,400 | $2,400 | $2,400 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,738 | $1,738 | $1,738 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,138 | $2,138 | $2,138 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $474 | $474 | $474 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $267 | $267 | $267 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $313 | $313 | $313 |
| Total hip replacement CPT 27130 • Orthopedics | $1,639 | $1,639 | $1,639 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,908 | $1,908 | $1,908 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,303 | $1,303 | $1,303 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,332 | $1,332 | $1,332 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,668 | $1,668 | $1,668 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,327 | $1,327 | $1,327 |
| Total knee replacement CPT 27447 • Orthopedics | $1,769 | $1,769 | $1,769 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $639 | $639 | $639 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $343 | $343 | $343 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $708 | $708 | $708 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $802 | $802 | $802 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,312 | $1,312 | $1,312 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $769 | $769 | $769 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $712 | $712 | $712 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $771 | $771 | $771 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,177 | $1,177 | $1,177 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,025 | $1,025 | $1,025 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,220 | $1,220 | $1,220 |
| Carpal tunnel release CPT 64721 • Orthopedics | $459 | $459 | $459 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $260 | $260 | $260 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $143 | $143 | $143 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $114 | $114 | $114 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $307 | $307 | $307 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $474 | $474 | $474 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $85 | $85 | $85 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $49 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $130 | $130 | $130 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $209 | $209 | $209 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $115 | $115 | $115 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $104 | $104 | $104 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $184 | $184 | $184 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $306 | $306 | $306 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $243 | $243 | $243 |
| Cytopathology concentration technique CPT 88108 • Pathology | $15 | $15 | $15 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $32 | $32 | $32 |
| 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 | $5 | $15 | $24 |
| 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 | $4 | $4 | $4 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $43 | $43 | $43 |