| Total knee replacement CPT 27447 • Orthopedics | $1,253 | $1,476 | $1,699 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $613 | $613 | $613 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $282 | $282 | $282 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $680 | $680 | $680 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $169 | $469 | $770 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,045 | $1,152 | $1,259 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $550 | $644 | $738 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $529 | $606 | $684 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $741 | $741 | $741 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $956 | $1,043 | $1,130 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $984 | $984 | $984 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,171 | $1,171 | $1,171 |
| Carpal tunnel release CPT 64721 • Orthopedics | $433 | $437 | $441 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $80 | $119 | $158 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $137 | $137 | $137 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $109 | $109 | $109 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $125 | $190 | $254 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $455 | $455 | $455 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $78 | $82 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $47 | $47 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $242 | $332 | $422 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $79 | $94 | $110 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $110 | $140 | $170 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $64 | $76 | $88 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $176 | $176 | $176 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $294 | $294 | $294 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $233 | $233 | $233 |
| Cytopathology concentration technique CPT 88108 • Pathology | $17 | $17 | $17 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $32 | $32 | $32 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |
| 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 | $13 | $13 | $13 |
| 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 | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $49 | $49 | $49 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $44 | $44 | $44 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $61 | $61 | $61 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $23 | $23 | $23 |
| Special stain group II CPT 88313 • Pathology | $27 | $27 | $27 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $11 | $11 | $11 |
| Frozen section pathology each additional CPT 88332 • Pathology | $4 | $4 | $4 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $22 | $22 | $22 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $23 | $23 | $23 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $61 | $92 |
| Microdissection manual CPT 88381 • Pathology | $99 | $129 | $159 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $8 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $10 | $11 |