| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $44 | $64 | $84 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $44 | $422 | $801 |
| Total hip replacement CPT 27130 • Orthopedics | $1,674 | $1,674 | $1,674 |
| Total knee replacement CPT 27447 • Orthopedics | $1,803 | $1,803 | $1,803 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $381 | $381 | $381 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $44 | $430 | $816 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,323 | $1,323 | $1,323 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $781 | $781 | $781 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $724 | $724 | $724 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,041 | $1,041 | $1,041 |
| Carpal tunnel release CPT 64721 • Orthopedics | $453 | $453 | $453 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $122 | $122 | $122 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $437 | $437 | $437 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $149 | $149 | $149 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $38 | $38 | $38 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $51 | $51 | $51 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $52 | $52 | $52 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $201 | $201 | $201 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $88 | $88 | $88 |
| Special stain group II CPT 88313 • Pathology | $62 | $62 | $62 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $104 | $104 | $104 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $45 | $74 | $104 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $18 | $18 | $18 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $20 | $20 | $20 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $15 | $15 | $15 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $36 | $36 | $36 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $36 | $36 | $36 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $31 | $31 | $31 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $33 | $33 | $33 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $36 | $36 | $36 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $37 | $37 | $37 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $7 | $7 | $7 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $21 | $21 | $21 |
| Spirometry CPT 94010 • Pulmonology | $44 | $44 | $44 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $68 | $68 | $68 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $44 | $44 | $44 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $30 | $44 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $21 | $21 | $21 |
| Polysomnography age 6 or older CPT 95810 • Sleep Medicine | $957 | $957 | $957 |
| Polysomnography with CPAP titration CPT 95811 • Sleep Medicine | $789 | $789 | $789 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $44 | $495 | $947 |
| Post-void residual urine measurement CPT 51798 • Urology | $19 | $19 | $19 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $192 | $192 | $192 |
| Circumcision CPT 54150 • Urology | $138 | $138 | $138 |
| Orchiectomy simple CPT 54520 • Urology | $44 | $44 | $44 |