| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $800 | $800 | $800 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $198 | $198 | $198 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,198 | $1,198 | $1,198 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $626 | $626 | $626 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $602 | $602 | $602 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $779 | $779 | $779 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,103 | $1,103 | $1,103 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $141 | $607 | $1,072 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,220 | $1,220 | $1,220 |
| Carpal tunnel release CPT 64721 • Orthopedics | $438 | $455 | $473 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $157 | $169 | $180 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,458 | $1,458 | $1,458 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $88 | $88 | $88 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $54 | $54 | $54 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $232 | $239 | $245 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $98 | $101 | $103 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $193 | $209 | $225 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $97 | $112 | $126 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $157 | $157 | $157 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $473 | $473 | $473 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $196 | $196 | $196 |
| Cytopathology concentration technique CPT 88108 • Pathology | $26 | $26 | $26 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $28 | $30 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $7 | $7 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $17 | $17 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $15 | $30 | $45 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $11 | $11 | $11 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $6 | $8 | $10 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $19 | $27 | $35 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $41 | $72 | $103 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $207 | $207 | $207 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $45 | $76 | $108 |
| Special stain group II CPT 88313 • Pathology | $5 | $15 | $25 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $31 | $31 |
| Frozen section pathology each additional CPT 88332 • Pathology | $6 | $6 | $6 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $27 | $27 | $27 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $25 | $34 | $44 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $62 | $62 | $62 |
| Microdissection manual CPT 88381 • Pathology | $22 | $25 | $27 |
| 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 | $23 | $26 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $25 | $28 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $22 | $23 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $22 | $25 |