| Fundus photography CPT 92250 • Ophthalmology | $20 | $40 | $58 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $34 | $84 | $129 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $35 | $80 | $133 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $105 | $157 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,072 | $3,335 | $5,459 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $256 | $3,037 | $5,100 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,716 | $3,718 | $5,943 |
| Total shoulder replacement CPT 23472 • Orthopedics | $230 | $2,306 | $3,521 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,520 | $2,835 | $3,924 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $276 | $716 | $1,026 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $198 | $547 | $827 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $296 | $717 | $1,449 |
| Total hip replacement CPT 27130 • Orthopedics | $895 | $2,192 | $3,124 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $274 | $2,650 | $4,062 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $994 | $2,052 | $2,904 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $188 | $1,947 | $2,987 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,327 | $2,273 | $2,985 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $176 | $1,831 | $2,808 |
| Total knee replacement CPT 27447 • Orthopedics | $940 | $2,213 | $3,121 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $79 | $872 | $1,415 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $216 | $524 | $770 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $559 | $1,471 | $2,153 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $373 | $734 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $989 | $1,851 | $2,604 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $420 | $982 | $1,370 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $366 | $935 | $1,319 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $704 | $1,263 | $1,679 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,078 | $1,807 | $2,381 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,204 | $2,104 | $3,131 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $169 | $2,165 | $3,549 |
| Carpal tunnel release CPT 64721 • Orthopedics | $559 | $741 | $1,048 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $83 | $219 | $396 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $135 | $501 | $853 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $108 | $276 | $452 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $98 | $417 | $840 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $271 | $2,108 | $7,550 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $33 | $101 | $184 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $69 | $116 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $138 | $299 | $587 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $64 | $148 | $305 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $74 | $214 | $421 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $60 | $94 | $129 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $119 | $194 | $291 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $275 | $554 | $997 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $74 | $242 | $412 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $8 | $51 | $81 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $41 | $79 | $127 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $25 | $33 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $17 | $22 |