| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $71 | $74 | $76 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $265 | $265 | $265 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,473 | $2,473 | $2,473 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,966 | $1,966 | $1,966 |
| Total knee replacement CPT 27447 • Orthopedics | $2,025 | $2,025 | $2,025 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $746 | $746 | $746 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $920 | $920 | $920 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $872 | $872 | $872 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $843 | $843 | $843 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $50 | $50 | $50 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,035 | $1,035 | $1,035 |
| Carpal tunnel release CPT 64721 • Orthopedics | $505 | $505 | $505 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $157 | $202 | $246 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $133 | $218 | $303 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $292 | $301 | $309 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $103 | $103 | $103 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $225 | $225 | $225 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $77 | $77 | $77 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $534 | $534 | $534 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $73 | $149 | $225 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $5 | $5 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $107 | $177 |
| Special stain group II CPT 88313 • Pathology | $5 | $5 | $5 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $13 | $13 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $16 | $16 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $39 | $39 | $39 |
| Microdissection manual CPT 88381 • Pathology | $144 | $144 | $144 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $13 | $13 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $12 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $13 | $16 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $24 | $27 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $26 | $29 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $22 | $24 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $23 | $26 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $17 | $17 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $75 | $75 | $76 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $31 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $27 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $26 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $32 | $32 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $29 | $29 |