| Fundus photography CPT 92250 • Ophthalmology | $28 | $47 | $58 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $34 | $62 | $78 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $35 | $56 | $90 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $39 | $76 | $113 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $238 | $1,942 | $3,128 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $217 | $1,949 | $3,157 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $240 | $2,082 | $3,371 |
| Total shoulder replacement CPT 23472 • Orthopedics | $201 | $1,484 | $2,291 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,671 | $2,194 | $3,003 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $268 | $449 | $665 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $245 | $361 | $511 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $174 | $422 | $785 |
| Total hip replacement CPT 27130 • Orthopedics | $895 | $1,596 | $2,188 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,451 | $2,018 | $2,561 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $731 | $1,321 | $1,790 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $30 | $1,146 | $1,763 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,327 | $1,774 | $2,159 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,011 | $1,485 | $1,705 |
| Total knee replacement CPT 27447 • Orthopedics | $1,344 | $1,845 | $2,349 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $77 | $539 | $855 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $160 | $351 | $479 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $451 | $831 | $1,403 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $284 | $745 | $1,019 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $989 | $1,312 | $1,661 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $381 | $774 | $1,032 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $582 | $777 | $962 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $671 | $850 | $1,039 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $136 | $1,030 | $1,500 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,204 | $1,722 | $2,886 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $169 | $1,731 | $3,694 |
| Carpal tunnel release CPT 64721 • Orthopedics | $251 | $508 | $625 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $83 | $178 | $374 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $129 | $281 | $440 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $103 | $218 | $363 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $98 | $292 | $520 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $550 | $1,315 | $3,428 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $73 | $107 | $148 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $32 | $59 | $86 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $92 | $265 | $476 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $27 | $165 | $305 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $100 | $231 | $410 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $42 | $99 | $159 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $119 | $227 | $390 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $260 | $548 | $817 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $69 | $223 | $395 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $8 | $36 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $19 | $54 | $82 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $26 | $41 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $15 | $26 |