| Fundus photography CPT 92250 • Ophthalmology | $30 | $30 | $30 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $50 | $50 | $50 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $50 | $50 | $50 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $52 | $52 | $52 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,850 | $1,850 | $1,850 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,929 | $1,929 | $1,929 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $237 | $237 | $237 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $261 | $261 | $261 |
| Total hip replacement CPT 27130 • Orthopedics | $2,007 | $2,007 | $2,007 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $2,260 | $2,260 | $2,260 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,385 | $1,385 | $1,385 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,367 | $1,367 | $1,367 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,563 | $1,563 | $1,563 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,664 | $1,664 | $1,664 |
| Total knee replacement CPT 27447 • Orthopedics | $2,140 | $2,140 | $2,140 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $682 | $682 | $682 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $231 | $231 | $231 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $773 | $773 | $773 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $964 | $964 | $964 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $916 | $916 | $916 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $795 | $795 | $795 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $855 | $855 | $855 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,414 | $1,414 | $1,414 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,332 | $1,332 | $1,332 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,713 | $1,713 | $1,713 |
| Carpal tunnel release CPT 64721 • Orthopedics | $427 | $427 | $427 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $737 | $737 | $737 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $86 | $86 | $86 |
| Cytopathology concentration technique CPT 88108 • Pathology | $33 | $33 | $33 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $56 | $56 | $56 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $98 | $98 | $98 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $133 | $133 | $133 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $25 | $25 | $25 |
| Special stain group II CPT 88313 • Pathology | $14 | $14 | $14 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $72 | $72 | $72 |
| Frozen section pathology each additional CPT 88332 • Pathology | $36 | $36 | $36 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $47 | $47 | $47 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $14 | $14 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $13 | $13 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $15 | $15 | $15 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $12 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $16 | $16 | $16 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $15 | $15 | $15 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $13 | $13 | $13 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $15 | $15 | $15 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $21 | $21 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $22 | $22 |