| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $573 | $573 | $573 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $725 | $725 | $725 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $881 | $952 | $1,022 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $895 | $895 | $895 |
| Carpal tunnel release CPT 64721 • Orthopedics | $425 | $425 | $425 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $179 | $179 | $179 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $263 | $263 | $263 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $260 | $289 | $318 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,386 | $2,386 | $2,386 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $8 | $25 | $41 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $55 | $62 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $304 | $304 | $304 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $111 | $111 | $111 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $218 | $218 | $218 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $101 | $113 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $143 | $143 | $143 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $444 | $444 | $444 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $240 | $244 | $249 |
| Cytopathology concentration technique CPT 88108 • Pathology | $20 | $29 | $38 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $34 | $34 | $34 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $20 | $20 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $12 | $16 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $20 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $37 | $37 | $37 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $170 | $214 | $258 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $390 | $390 | $390 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $99 | $99 | $99 |
| Special stain group II CPT 88313 • Pathology | $48 | $60 | $72 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $60 | $60 | $60 |
| Frozen section pathology each additional CPT 88332 • Pathology | $49 | $49 | $49 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $52 | $65 | $77 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $60 | $74 | $89 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $32 | $52 | $71 |
| Microdissection manual CPT 88381 • Pathology | $178 | $178 | $178 |
| 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 | $7 | $8 | $9 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $9 | $10 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $9 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $22 | $22 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $25 | $25 | $25 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $22 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $22 | $22 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $13 | $13 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $61 | $61 | $61 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $42 | $42 | $43 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $25 | $25 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $24 | $24 | $24 |