| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $682 | $682 | $682 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $963 | $963 | $963 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $838 | $891 | $944 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $953 | $1,012 | $1,071 |
| Carpal tunnel release CPT 64721 • Orthopedics | $356 | $387 | $417 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $40 | $90 | $128 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $106 | $174 | $242 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $149 | $149 | $149 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $85 | $174 | $242 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $409 | $1,125 | $1,841 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $67 | $71 | $75 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $39 | $51 | $67 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $110 | $211 | $348 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $52 | $76 | $103 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $137 | $157 | $167 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $69 | $89 | $127 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $120 | $122 | $125 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $220 | $294 | $332 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $136 | $250 | $449 |
| Cytopathology concentration technique CPT 88108 • Pathology | $41 | $42 | $43 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $35 | $49 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $19 | $23 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $10 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $12 | $19 | $23 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $10 | $15 | $19 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $22 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $8 | $19 | $29 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $27 | $30 | $33 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $59 | $145 | $188 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $174 | $225 | $275 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $39 | $58 | $68 |
| Special stain group II CPT 88313 • Pathology | $32 | $67 | $145 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $47 | $57 | $66 |
| Frozen section pathology each additional CPT 88332 • Pathology | $14 | $26 | $38 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $20 | $39 | $65 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $46 | $58 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $33 | $44 | $56 |
| Microdissection manual CPT 88381 • Pathology | $85 | $85 | $86 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $12 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $10 | $12 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $12 | $15 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $10 | $14 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $17 | $22 | $30 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $20 | $26 | $34 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $17 | $22 | $30 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $16 | $21 | $27 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $14 | $18 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $48 | $69 | $83 |