| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $795 | $2,362 | $4,628 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $223 | $789 | $1,348 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $292 | $3,147 | $9,961 |
| Total shoulder replacement CPT 23472 • Orthopedics | $203 | $746 | $1,240 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $226 | $800 | $1,378 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $365 | $599 | $795 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $73 | $344 | $795 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $189 | $580 | $832 |
| Total hip replacement CPT 27130 • Orthopedics | $795 | $1,278 | $1,936 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $795 | $3,209 | $9,555 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $168 | $664 | $1,027 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $795 | $1,029 | $1,236 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $795 | $1,234 | $1,851 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $162 | $1,395 | $3,634 |
| Total knee replacement CPT 27447 • Orthopedics | $206 | $1,690 | $4,656 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $371 | $561 | $795 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $189 | $414 | $795 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $73 | $541 | $795 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $27 | $632 | $1,562 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $679 | $1,347 | $2,994 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $490 | $619 | $795 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $347 | $538 | $795 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $440 | $819 | $1,442 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $619 | $1,729 | $4,661 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $787 | $993 | $1,396 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $707 | $817 | $948 |
| Carpal tunnel release CPT 64721 • Orthopedics | $390 | $637 | $915 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $124 | $1,083 | $3,272 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $92 | $344 | $795 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $67 | $327 | $795 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $85 | $326 | $795 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $415 | $1,033 | $1,888 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $36 | $291 | $795 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $17 | $222 | $795 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $166 | $390 | $795 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $51 | $282 | $795 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $135 | $361 | $795 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $44 | $296 | $795 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $103 | $341 | $795 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $166 | $467 | $795 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $87 | $361 | $795 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $219 | $507 | $795 |
| Cytopathology concentration technique CPT 88108 • Pathology | $0 | $86 | $238 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $1 | $100 | $259 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $0 | $38 | $100 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $5 | $8 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $5 | $15 | $25 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $5 | $12 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $0 | $48 | $131 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $0 | $49 | $117 |