| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $346 | $905 | $1,465 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,354 | $1,354 | $1,354 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,593 | $1,593 | $1,593 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,291 | $1,291 | $1,291 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,576 | $1,576 | $1,576 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $412 | $412 | $412 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $247 | $387 | $528 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $445 | $471 | $498 |
| Total hip replacement CPT 27130 • Orthopedics | $1,243 | $1,519 | $1,794 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,631 | $1,631 | $1,631 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,029 | $1,029 | $1,029 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,059 | $1,059 | $1,059 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,071 | $1,399 | $1,727 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $956 | $1,349 | $1,743 |
| Total knee replacement CPT 27447 • Orthopedics | $1,329 | $1,636 | $1,944 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $494 | $494 | $494 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $269 | $269 | $269 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $459 | $542 | $625 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $258 | $417 | $576 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $932 | $1,278 | $1,624 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $595 | $595 | $595 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $557 | $694 | $831 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $601 | $827 | $1,054 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $854 | $854 | $854 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $817 | $817 | $817 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $929 | $1,298 | $1,666 |
| Carpal tunnel release CPT 64721 • Orthopedics | $368 | $511 | $653 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $110 | $139 | $169 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $231 | $237 | $242 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $144 | $144 | $144 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $215 | $221 | $227 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $357 | $361 | $366 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $65 | $79 | $92 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $43 | $44 | $44 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $220 | $226 | $232 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $97 | $100 | $103 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $159 | $163 | $167 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $79 | $103 | $127 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $123 | $181 | $238 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $408 | $479 | $551 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $173 | $234 | $295 |
| Cytopathology concentration technique CPT 88108 • Pathology | $66 | $66 | $66 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $31 | $60 | $89 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $18 | $25 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $22 | $31 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $17 | $17 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $47 | $47 | $47 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $19 | $37 | $55 |