| Total knee replacement CPT 27447 • Orthopedics | $1,699 | $1,699 | $1,699 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $613 | $613 | $613 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $329 | $329 | $329 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $680 | $680 | $680 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $770 | $770 | $770 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,259 | $1,259 | $1,259 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $738 | $738 | $738 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $684 | $684 | $684 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $741 | $741 | $741 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,130 | $1,130 | $1,130 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $984 | $984 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,171 | $1,171 | $1,171 |
| Carpal tunnel release CPT 64721 • Orthopedics | $441 | $441 | $441 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $250 | $250 | $250 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $137 | $137 | $137 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $189 | $189 | $189 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $295 | $295 | $295 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $455 | $455 | $455 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $114 | $114 | $114 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $59 | $59 | $59 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $422 | $422 | $422 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $201 | $201 | $201 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $110 | $110 | $110 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $64 | $64 | $64 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $176 | $176 | $176 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $558 | $558 | $558 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $79 | $79 | $79 |
| Cytopathology concentration technique CPT 88108 • Pathology | $17 | $17 | $17 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $26 | $26 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $5 | $5 | $5 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $5 | $5 | $5 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $5 | $5 | $5 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $13 | $13 | $13 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $87 | $87 | $87 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $61 | $61 | $61 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $23 | $23 | $23 |
| Special stain group II CPT 88313 • Pathology | $20 | $20 | $20 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $11 | $11 | $11 |
| Frozen section pathology each additional CPT 88332 • Pathology | $20 | $20 | $20 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $11 | $11 | $11 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $23 | $23 | $23 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $22 | $72 | $121 |
| Microdissection manual CPT 88381 • Pathology | $73 | $128 | $184 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $10 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $13 | $14 |