| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $339 | $5,023 | $16,631 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $2,040 | $5,818 | $16,631 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,050 | $8,176 | $23,952 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,313 | $6,368 | $19,963 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $462 | $4,924 | $14,813 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $452 | $2,591 | $7,926 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $271 | $476 | $682 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $152 | $1,524 | $5,919 |
| Total hip replacement CPT 27130 • Orthopedics | $369 | $5,029 | $19,963 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,451 | $6,880 | $19,963 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $994 | $5,499 | $16,631 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $404 | $5,019 | $16,631 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,027 | $4,145 | $14,813 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,011 | $6,298 | $19,963 |
| Total knee replacement CPT 27447 • Orthopedics | $422 | $5,182 | $19,963 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $169 | $2,415 | $7,926 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $314 | $603 | $919 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $559 | $3,505 | $11,257 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $219 | $480 | $734 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $353 | $4,915 | $16,631 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $603 | $2,839 | $11,257 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $461 | $2,985 | $11,257 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $704 | $3,099 | $11,257 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $281 | $4,105 | $16,631 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $783 | $4,272 | $16,631 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $321 | $5,039 | $16,631 |
| Carpal tunnel release CPT 64721 • Orthopedics | $440 | $2,036 | $7,926 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $83 | $290 | $682 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $100 | $602 | $2,195 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $103 | $649 | $2,195 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $118 | $620 | $2,195 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $550 | $4,548 | $16,631 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $488 | $2,195 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $43 | $195 | $682 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $94 | $585 | $2,195 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $83 | $221 | $682 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $100 | $598 | $2,195 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $58 | $231 | $682 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $142 | $289 | $682 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $260 | $1,941 | $7,926 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $69 | $259 | $682 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $682 | $682 | $682 |
| Cytopathology concentration technique CPT 88108 • Pathology | $10 | $38 | $61 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $18 | $78 | $129 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $21 | $27 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $12 | $15 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $26 | $37 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $19 | $21 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $24 | $28 | $34 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $3 | $26 | $52 |