| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $220 | $220 | $220 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $176 | $176 | $176 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $155 | $155 | $155 |
| Total hip replacement CPT 27130 • Orthopedics | $94 | $94 | $94 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $139 | $139 | $139 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $392 | $392 | $392 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $90 | $90 | $90 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $89 | $89 | $89 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $377 | $377 | $377 |
| Total knee replacement CPT 27447 • Orthopedics | $107 | $107 | $107 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $458 | $458 | $458 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $155 | $155 | $155 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $43 | $43 | $43 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $56 | $56 | $56 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $89 | $89 | $89 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $444 | $444 | $444 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $180 | $180 | $180 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $361 | $361 | $361 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $763 | $763 | $763 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $67 | $67 | $67 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $81 | $81 | $81 |
| Carpal tunnel release CPT 64721 • Orthopedics | $347 | $347 | $347 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $27 | $27 | $27 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $55 | $55 | $55 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $61 | $61 | $61 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $77 | $77 | $77 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $135 | $135 | $135 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $14 | $14 | $14 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $26 | $26 | $26 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $36 | $36 | $36 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $26 | $26 | $26 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $70 | $70 | $70 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $39 | $39 | $39 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $64 | $64 | $64 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $149 | $149 | $149 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $30 | $30 | $30 |
| Cytopathology concentration technique CPT 88108 • Pathology | $28 | $28 | $28 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $19 | $19 | $19 |
| 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 | $3 | $3 | $3 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $35 | $35 | $35 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $164 | $164 | $164 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $40 | $40 | $40 |
| Special stain group II CPT 88313 • Pathology | $24 | $24 | $24 |