| Total hip replacement CPT 27130 • Orthopedics | $41 | $2,770 | $5,500 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $53 | $53 | $53 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $38 | $905 | $1,771 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $39 | $39 | $39 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $39 | $1,744 | $3,449 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $36 | $36 | $36 |
| Total knee replacement CPT 27447 • Orthopedics | $41 | $2,037 | $4,033 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $824 | $824 | $824 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $10 | $244 | $479 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $723 | $1,063 | $1,403 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $5 | $427 | $848 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $34 | $812 | $1,590 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $800 | $1,673 | $2,546 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $771 | $1,447 | $2,122 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $977 | $1,002 | $1,028 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $31 | $1,926 | $3,821 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $29 | $1,458 | $2,886 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $35 | $1,864 | $3,694 |
| Carpal tunnel release CPT 64721 • Orthopedics | $638 | $841 | $1,043 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $5 | $190 | $374 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $8 | $201 | $394 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $230 | $362 | $494 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $8 | $264 | $520 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $71 | $1,750 | $3,428 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $117 | $213 | $309 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $70 | $73 | $76 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $8 | $88 | $169 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $71 | $120 | $168 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $6 | $153 | $300 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $71 | $104 | $137 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $5 | $197 | $390 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $742 | $766 | $791 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $8 | $185 | $362 |
| Cytopathology concentration technique CPT 88108 • Pathology | $96 | $96 | $96 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $96 | $96 | $96 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $33 | $36 | $39 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $24 | $24 | $24 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $37 | $37 | $37 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $30 | $30 | $30 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $46 | $46 | $46 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $9 | $9 | $9 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $62 | $62 | $62 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $51 | $95 | $138 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $9 | $9 | $9 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $633 | $633 | $633 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $37 | $97 | $158 |
| Special stain group II CPT 88313 • Pathology | $3 | $58 | $113 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $86 | $119 | $152 |
| Frozen section pathology each additional CPT 88332 • Pathology | $79 | $81 | $84 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $86 | $113 | $140 |