| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,721 | $1,721 | $1,721 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,592 | $1,592 | $1,592 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,824 | $1,824 | $1,824 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,434 | $1,434 | $1,434 |
| Total hip replacement CPT 27130 • Orthopedics | $1,275 | $1,275 | $1,275 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,657 | $1,657 | $1,657 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,186 | $1,186 | $1,186 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,219 | $1,219 | $1,219 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,141 | $1,141 | $1,141 |
| Total knee replacement CPT 27447 • Orthopedics | $1,274 | $1,274 | $1,275 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $580 | $580 | $581 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $872 | $872 | $873 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,064 | $1,064 | $1,064 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $564 | $564 | $564 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $543 | $543 | $543 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $915 | $915 | $915 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,107 | $1,107 | $1,107 |
| Carpal tunnel release CPT 64721 • Orthopedics | $442 | $442 | $442 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $161 | $161 | $161 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $77 | $77 | $77 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $254 | $254 | $254 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $241 | $241 | $241 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $172 | $172 | $172 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $88 | $88 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $154 | $154 | $154 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $433 | $433 | $434 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $239 | $239 | $239 |
| Cytopathology concentration technique CPT 88108 • Pathology | $53 | $53 | $53 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $53 | $53 | $53 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $18 | $18 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $19 | $19 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $15 | $15 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $25 | $25 |
| 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 IV CPT 88305 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $233 | $233 | $233 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $351 | $351 | $351 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $90 | $90 | $90 |
| Special stain group II CPT 88313 • Pathology | $66 | $66 | $66 |
| Frozen section pathology each additional CPT 88332 • Pathology | $43 | $43 | $43 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $69 | $69 | $69 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $80 | $80 | $80 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $31 | $31 | $31 |
| Microdissection manual CPT 88381 • Pathology | $163 | $163 | $163 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |