| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $441 | $441 | $441 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $313 | $313 | $313 |
| Total hip replacement CPT 27130 • Orthopedics | $30 | $30 | $30 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $30 | $30 | $30 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,274 | $1,274 | $1,274 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,272 | $1,272 | $1,272 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $30 | $30 | $30 |
| Total knee replacement CPT 27447 • Orthopedics | $30 | $679 | $1,328 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $30 | $321 | $611 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $30 | $483 | $937 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $301 | $571 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $722 | $722 | $722 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,015 | $1,015 | $1,015 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $30 | $30 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $30 | $30 | $30 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $30 | $30 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $173 | $173 | $173 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $282 | $282 | $282 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $278 | $278 | $278 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $53 | $53 | $53 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $192 | $192 | $192 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $97 | $97 | $97 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $166 | $166 | $166 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $460 | $464 | $468 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $260 | $260 | $260 |
| Cytopathology concentration technique CPT 88108 • Pathology | $51 | $51 | $51 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $57 | $57 | $57 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $27 | $27 | $27 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $25 | $25 | $25 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $26 | $26 | $26 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $34 | $34 | $34 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $229 | $245 | $260 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $349 | $349 | $349 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $85 | $85 | $85 |
| Special stain group II CPT 88313 • Pathology | $61 | $61 | $61 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $37 | $37 | $37 |
| Frozen section pathology each additional CPT 88332 • Pathology | $45 | $45 | $45 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $79 | $79 | $79 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $91 | $91 | $91 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $71 | $71 | $71 |
| Microdissection manual CPT 88381 • Pathology | $131 | $131 | $131 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |