| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,473 | $1,473 | $1,473 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,384 | $1,384 | $1,384 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,608 | $1,608 | $1,608 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $375 | $375 | $375 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $285 | $285 | $285 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $520 | $520 | $520 |
| Total hip replacement CPT 27130 • Orthopedics | $1,139 | $1,139 | $1,139 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,480 | $1,480 | $1,480 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,057 | $1,057 | $1,057 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,088 | $1,088 | $1,088 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,023 | $1,023 | $1,023 |
| Total knee replacement CPT 27447 • Orthopedics | $1,137 | $1,137 | $1,138 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $512 | $512 | $512 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $813 | $813 | $814 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $948 | $948 | $948 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $498 | $498 | $498 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $481 | $481 | $481 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $868 | $868 | $868 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $882 | $882 | $882 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,000 | $1,000 | $1,000 |
| Carpal tunnel release CPT 64721 • Orthopedics | $407 | $407 | $407 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $75 | $111 | $148 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $246 | $246 | $246 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $45 | $45 | $45 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $230 | $230 | $230 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $165 | $165 | $165 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $85 | $85 | $85 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $138 | $138 | $138 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $391 | $391 | $392 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $161 | $161 | $162 |
| Cytopathology concentration technique CPT 88108 • Pathology | $43 | $43 | $43 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $46 | $46 | $46 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |
| 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 | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $197 | $197 | $198 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $302 | $302 | $302 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $76 | $76 | $76 |
| Special stain group II CPT 88313 • Pathology | $55 | $55 | $55 |
| Frozen section pathology each additional CPT 88332 • Pathology | $38 | $38 | $38 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $64 | $64 | $64 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $72 | $72 | $72 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $55 | $55 | $55 |
| Microdissection manual CPT 88381 • Pathology | $138 | $138 | $138 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $7 | $7 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $7 | $7 |