| Fundus photography CPT 92250 • Ophthalmology | $26 | $48 | $93 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $29 | $42 | $55 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $35 | $61 | $85 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $74 | $102 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,072 | $1,871 | $2,511 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $977 | $1,932 | $3,157 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $240 | $1,892 | $2,669 |
| Total shoulder replacement CPT 23472 • Orthopedics | $230 | $1,390 | $2,146 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,623 | $2,049 | $2,467 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $268 | $460 | $636 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $245 | $348 | $511 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $296 | $605 | $1,032 |
| Total hip replacement CPT 27130 • Orthopedics | $1,249 | $2,248 | $5,500 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,048 | $1,758 | $2,542 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $994 | $1,309 | $1,771 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,075 | $1,370 | $1,865 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,247 | $1,934 | $3,449 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $176 | $1,109 | $1,758 |
| Total knee replacement CPT 27447 • Orthopedics | $940 | $1,905 | $4,033 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $88 | $563 | $768 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $160 | $336 | $479 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $63 | $764 | $1,403 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $171 | $432 | $848 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $989 | $1,211 | $1,590 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $582 | $1,114 | $2,546 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $366 | $874 | $2,122 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $704 | $856 | $1,028 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $992 | $1,724 | $3,821 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $936 | $1,281 | $1,695 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $665 | $1,649 | $3,694 |
| Carpal tunnel release CPT 64721 • Orthopedics | $251 | $563 | $1,043 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $83 | $151 | $263 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $162 | $338 | $466 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $78 | $166 | $239 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $98 | $248 | $400 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $418 | $1,491 | $3,428 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $33 | $95 | $178 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $60 | $81 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $138 | $311 | $473 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $64 | $97 | $128 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $74 | $215 | $400 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $42 | $97 | $137 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $154 | $189 | $253 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $216 | $568 | $791 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $58 | $188 | $390 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $10 | $46 | $81 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $73 | $127 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $23 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $13 | $18 |