| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,579 | $1,579 | $1,579 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,473 | $1,473 | $1,473 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,718 | $1,718 | $1,718 |
| Total hip replacement CPT 27130 • Orthopedics | $1,193 | $1,193 | $1,193 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,552 | $1,552 | $1,552 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,109 | $1,109 | $1,109 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,072 | $1,072 | $1,072 |
| Total knee replacement CPT 27447 • Orthopedics | $1,192 | $1,192 | $1,192 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $540 | $540 | $540 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $459 | $700 | $821 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $994 | $994 | $994 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $523 | $523 | $523 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $504 | $504 | $504 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $30 | $30 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $895 | $895 | $895 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,014 | $1,014 | $1,014 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $110 | $130 | $151 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $242 | $242 | $242 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $85 | $162 | $239 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $357 | $357 | $357 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $45 | $56 | $67 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $348 | $348 | $348 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $155 | $155 | $155 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $160 | $164 | $167 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $83 | $105 | $127 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $141 | $141 | $141 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $410 | $410 | $410 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $226 | $226 | $226 |
| Cytopathology concentration technique CPT 88108 • Pathology | $50 | $50 | $50 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $31 | $41 | $52 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $14 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $12 | $16 | $21 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $26 | $26 | $26 |
| 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 | $26 | $32 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $33 | $33 | $33 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $45 | $134 | $223 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $340 | $340 | $340 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $39 | $64 | $88 |
| Special stain group II CPT 88313 • Pathology | $32 | $48 | $63 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $31 | $31 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $42 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $44 | $56 | $69 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $52 | $66 | $79 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $94 | $94 | $94 |
| Microdissection manual CPT 88381 • Pathology | $163 | $163 | $163 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $10 | $12 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |