| Total shoulder replacement CPT 23472 • Orthopedics | $41 | $1,022 | $1,506 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,545 | $1,545 | $1,545 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $342 | $388 | $410 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $41 | $91 | $187 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $41 | $353 | $548 |
| Total hip replacement CPT 27130 • Orthopedics | $41 | $630 | $1,313 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $41 | $965 | $1,537 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $41 | $683 | $1,089 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $41 | $728 | $1,236 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $41 | $801 | $1,251 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $41 | $643 | $1,011 |
| Total knee replacement CPT 27447 • Orthopedics | $41 | $673 | $1,404 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $41 | $174 | $440 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $41 | $197 | $319 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $41 | $416 | $668 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $41 | $203 | $524 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $41 | $627 | $986 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $41 | $401 | $632 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $41 | $292 | $592 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $41 | $207 | $534 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $41 | $285 | $772 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $41 | $546 | $870 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $41 | $621 | $989 |
| Carpal tunnel release CPT 64721 • Orthopedics | $41 | $252 | $394 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $41 | $51 | $64 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $103 | $171 | $240 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $142 | $142 | $142 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $222 | $232 | $236 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $554 | $1,239 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $64 | $81 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $35 | $42 | $46 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $41 | $122 | $240 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $41 | $46 | $53 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $173 | $185 | $211 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $38 | $73 | $85 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $127 | $129 | $133 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $420 | $424 | $426 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $59 | $154 | $195 |
| Cytopathology concentration technique CPT 88108 • Pathology | $16 | $39 | $77 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $61 | $90 | $109 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $24 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $12 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $28 | $32 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $15 | $15 | $15 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $39 | $60 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $35 | $66 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $21 | $55 | $109 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $45 | $173 | $248 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $170 | $294 | $373 |