| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,284 | $1,284 | $1,284 |
| Total knee replacement CPT 27447 • Orthopedics | $1,786 | $1,786 | $1,786 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $661 | $661 | $661 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $831 | $831 | $832 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $159 | $159 | $159 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,250 | $1,250 | $1,250 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $798 | $798 | $798 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $746 | $746 | $747 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $32 | $32 | $32 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,363 | $1,363 | $1,363 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,552 | $1,552 | $1,552 |
| Carpal tunnel release CPT 64721 • Orthopedics | $609 | $609 | $609 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $223 | $223 | $223 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $94 | $94 | $94 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $76 | $76 | $76 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $376 | $376 | $376 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $32 | $32 | $32 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $68 | $68 | $68 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $71 | $71 | $71 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $359 | $359 | $359 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $45 | $45 | $45 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $261 | $261 | $261 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $130 | $130 | $130 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $209 | $209 | $209 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $666 | $666 | $666 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $144 | $212 | $281 |
| Cytopathology concentration technique CPT 88108 • Pathology | $62 | $62 | $62 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $84 | $84 | $84 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $23 | $23 | $23 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $30 | $30 | $30 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $24 | $24 | $24 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $44 | $44 | $44 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $52 | $52 | $52 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $47 | $47 | $47 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $189 | $189 | $189 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $285 | $285 | $285 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $89 | $89 | $89 |
| Special stain group II CPT 88313 • Pathology | $65 | $65 | $65 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $68 | $68 | $68 |
| Frozen section pathology each additional CPT 88332 • Pathology | $33 | $33 | $33 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $57 | $57 | $57 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $86 | $86 | $86 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $92 | $92 | $92 |
| Microdissection manual CPT 88381 • Pathology | $154 | $154 | $154 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $9 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $9 | $9 |