| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $449 | $449 | $449 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $387 | $387 | $387 |
| Total hip replacement CPT 27130 • Orthopedics | $2,383 | $2,383 | $2,383 |
| Total knee replacement CPT 27447 • Orthopedics | $1,509 | $1,670 | $1,831 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $687 | $687 | $687 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $376 | $401 | $426 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,055 | $1,055 | $1,055 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $237 | $237 | $237 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,444 | $1,444 | $1,444 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $755 | $755 | $755 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $641 | $684 | $727 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,324 | $1,324 | $1,324 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,986 | $1,986 | $1,986 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $204 | $204 |
| Carpal tunnel release CPT 64721 • Orthopedics | $586 | $586 | $586 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $170 | $182 | $194 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $284 | $284 | $284 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $92 | $92 | $92 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $301 | $329 | $357 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $1,657 | $2,719 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $48 | $48 | $48 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $57 | $62 | $66 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $126 | $206 | $287 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $137 | $137 | $137 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $201 | $276 | $351 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $104 | $143 | $181 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $199 | $199 | $199 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $44 | $147 | $250 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $86 | $219 | $285 |
| Cytopathology concentration technique CPT 88108 • Pathology | $49 | $49 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $50 | $50 | $50 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $17 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $39 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $16 | $16 |
| 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 | $31 | $31 | $31 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $54 | $54 | $54 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $218 | $218 | $218 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $331 | $331 | $331 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $85 | $85 | $85 |
| Special stain group II CPT 88313 • Pathology | $61 | $61 | $61 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $47 | $47 | $47 |
| Frozen section pathology each additional CPT 88332 • Pathology | $41 | $41 | $41 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $67 | $67 | $67 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $77 | $77 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $92 | $92 | $92 |
| Microdissection manual CPT 88381 • Pathology | $159 | $159 | $159 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $13 | $19 |