| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,540 | $1,540 | $1,540 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $1,103 | $1,103 | $1,103 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,061 | $1,061 | $1,061 |
| Total knee replacement CPT 27447 • Orthopedics | $1,184 | $1,184 | $1,185 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $540 | $540 | $540 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $827 | $827 | $828 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $991 | $991 | $991 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $524 | $524 | $524 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $505 | $505 | $505 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $830 | $830 | $830 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,003 | $1,003 | $1,003 |
| Carpal tunnel release CPT 64721 • Orthopedics | $415 | $415 | $415 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $153 | $153 | $153 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $241 | $241 | $241 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,142 | $2,142 | $2,142 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $70 | $70 | $70 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $47 | $47 | $47 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $230 | $230 | $230 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $164 | $164 | $164 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $84 | $84 | $84 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $138 | $138 | $138 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $413 | $413 | $414 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $226 | $226 | $226 |
| Cytopathology concentration technique CPT 88108 • Pathology | $50 | $50 | $50 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $51 | $51 | $51 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $17 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $21 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $24 | $24 | $24 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $32 | $32 | $32 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $221 | $221 | $222 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $335 | $335 | $335 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $85 | $85 | $85 |
| Special stain group II CPT 88313 • Pathology | $62 | $62 | $62 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $42 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $66 | $66 | $66 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $76 | $76 | $76 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $90 | $90 | $90 |
| Microdissection manual CPT 88381 • Pathology | $153 | $153 | $153 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $8 | $8 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $10 | $10 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $23 | $23 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |