| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,608 | $3,745 | $7,025 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $2,024 | $3,505 | $7,025 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,783 | $5,909 | $15,048 |
| Total shoulder replacement CPT 23472 • Orthopedics | $235 | $4,153 | $11,808 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $2,550 | $3,710 | $6,029 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $658 | $1,745 | $3,920 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $360 | $456 | $504 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $388 | $955 | $1,725 |
| Total hip replacement CPT 27130 • Orthopedics | $1,666 | $4,432 | $11,808 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $2,628 | $5,688 | $11,808 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,070 | $2,960 | $7,025 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,928 | $3,627 | $7,025 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,928 | $3,295 | $6,029 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,492 | $4,233 | $11,808 |
| Total knee replacement CPT 27447 • Orthopedics | $156 | $4,054 | $11,808 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $898 | $1,905 | $3,920 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $305 | $409 | $487 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,432 | $2,652 | $5,092 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $18 | $234 | $360 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $122 | $2,615 | $7,025 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $708 | $1,889 | $5,092 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $236 | $1,754 | $5,092 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $809 | $2,023 | $5,092 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,542 | $3,370 | $7,025 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,513 | $3,351 | $7,025 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,669 | $3,034 | $7,025 |
| Carpal tunnel release CPT 64721 • Orthopedics | $624 | $1,469 | $3,920 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $219 | $268 | $360 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $255 | $481 | $903 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $241 | $462 | $903 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $252 | $476 | $903 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,011 | $3,683 | $7,025 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $124 | $383 | $903 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $137 | $360 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $313 | $472 | $903 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $81 | $178 | $360 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $264 | $424 | $903 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $179 | $360 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $222 | $268 | $360 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $385 | $1,396 | $3,920 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $205 | $273 | $360 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $360 | $2,821 | $5,281 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $12 | $38 | $51 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $15 | $17 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $19 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $24 | $24 | $24 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $19 | $27 | $32 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $33 | $48 | $55 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $128 | $189 | $219 |