| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,019 | $1,019 | $1,019 |
| Total knee replacement CPT 27447 • Orthopedics | $1,062 | $1,179 | $1,296 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $592 | $592 | $592 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $248 | $248 | $248 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $766 | $842 | $919 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $142 | $142 | $142 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $891 | $891 | $891 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $472 | $472 | $472 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $455 | $503 | $552 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $577 | $577 | $577 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $815 | $815 | $815 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $817 | $817 | $817 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $924 | $924 | $924 |
| Carpal tunnel release CPT 64721 • Orthopedics | $385 | $385 | $385 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $141 | $155 | $169 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $92 | $177 | $262 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $69 | $69 | $69 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $233 | $233 | $233 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,124 | $2,124 | $2,124 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $67 | $67 | $67 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $43 | $43 | $43 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $222 | $222 | $222 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $44 | $44 | $44 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $155 | $155 | $155 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $80 | $80 | $80 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $130 | $130 | $130 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $399 | $421 | $443 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $12 | $117 | $222 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $16 | $16 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $26 | $26 | $26 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $209 | $209 | $209 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $70 | $70 | $70 |
| Special stain group II CPT 88313 • Pathology | $50 | $50 | $50 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $25 | $25 | $25 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $55 | $55 | $55 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $63 | $63 | $63 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $25 | $25 | $25 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $6 | $6 | $6 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $6 | $6 | $6 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $7 | $7 | $7 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $7 | $7 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $14 | $14 | $14 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $16 | $16 | $16 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $14 | $14 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $13 | $13 | $13 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $8 | $8 | $8 |