| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $53 | $53 | $53 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,710 | $1,710 | $1,710 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,462 | $1,462 | $1,462 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $369 | $369 | $369 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,106 | $1,106 | $1,106 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $30 | $30 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $30 | $30 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $515 | $515 | $515 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $30 | $30 | $30 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $482 | $482 | $482 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $30 | $30 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $30 | $30 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $30 | $30 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $210 | $210 | $210 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $207 | $207 | $207 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $30 | $30 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $30 | $30 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $41 | $41 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $74 | $74 | $74 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $133 | $133 | $133 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $353 | $353 | $353 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $145 | $145 | $145 |
| Cytopathology concentration technique CPT 88108 • Pathology | $42 | $42 | $42 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $10 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $182 | $182 | $182 |
| Special stain group II CPT 88313 • Pathology | $48 | $48 | $48 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $68 | $68 | $68 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $64 | $64 | $64 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $76 | $76 | $76 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $92 | $92 | $92 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $9 | $9 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $23 | $23 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $18 | $18 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $18 | $18 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $66 | $66 | $66 |