| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,678 | $1,678 | $1,678 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,304 | $6,133 | $9,961 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,414 | $1,541 | $1,669 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,053 | $2,053 | $2,053 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $455 | $455 | $455 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $100 | $202 | $303 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $638 | $1,145 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $802 | $1,574 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,832 | $5,693 | $9,555 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,251 | $1,251 | $1,251 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,279 | $1,279 | $1,279 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,601 | $1,601 | $1,601 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,274 | $3,135 | $4,997 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $2,128 | $4,656 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $613 | $613 | $613 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $282 | $282 | $282 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $680 | $772 | $865 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $770 | $1,166 | $1,562 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $1,428 | $2,994 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $384 | $738 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $357 | $684 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $674 | $1,132 | $1,982 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $1,940 | $4,661 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $984 | $984 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,171 | $1,171 | $1,171 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $576 | $1,258 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $80 | $2,290 | $4,499 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $137 | $294 | $452 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $109 | $109 | $109 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $125 | $125 | $125 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $455 | $455 | $455 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $82 | $82 | $82 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $24 | $35 | $47 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $422 | $422 | $422 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $79 | $168 | $258 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $110 | $110 | $110 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $64 | $64 | $64 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $176 | $176 | $176 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $294 | $573 | $852 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $233 | $233 | $233 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $301 | $301 | $301 |
| Cytopathology concentration technique CPT 88108 • Pathology | $17 | $17 | $17 |
| 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 | $17 | $17 | $17 |
| 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 | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $22 | $22 | $22 |