| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $75 | $75 | $75 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,095 | $2,095 | $2,095 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,610 | $1,610 | $1,610 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,250 | $2,250 | $2,250 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,580 | $1,580 | $1,580 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,988 | $1,988 | $1,988 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $439 | $439 | $439 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $306 | $306 | $306 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $711 | $711 | $711 |
| Total hip replacement CPT 27130 • Orthopedics | $1,516 | $1,516 | $1,516 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,763 | $1,763 | $1,763 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,203 | $1,203 | $1,203 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,233 | $1,233 | $1,233 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,545 | $1,545 | $1,545 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,224 | $1,224 | $1,224 |
| Total knee replacement CPT 27447 • Orthopedics | $1,632 | $1,632 | $1,632 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $593 | $593 | $593 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $342 | $342 | $342 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $776 | $776 | $776 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $738 | $738 | $738 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,193 | $1,193 | $1,193 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $706 | $706 | $706 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $653 | $653 | $653 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $703 | $703 | $703 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,086 | $1,086 | $1,086 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $825 | $825 | $825 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $988 | $988 | $988 |
| Carpal tunnel release CPT 64721 • Orthopedics | $354 | $354 | $354 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $437 | $437 | $437 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $249 | $249 | $249 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $157 | $157 | $157 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $245 | $245 | $245 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,366 | $1,366 | $1,366 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $94 | $94 | $94 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $49 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $337 | $337 | $337 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $150 | $150 | $150 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $214 | $214 | $214 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $102 | $102 | $102 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $150 | $150 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $462 | $462 | $462 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $193 | $193 | $193 |
| Cytopathology concentration technique CPT 88108 • Pathology | $30 | $30 | $30 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $38 | $38 | $38 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $22 | $22 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $18 | $18 |