| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $699 | $699 | $699 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $966 | $1,218 | $1,348 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $38 | $1,113 | $3,121 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $38 | $453 | $1,117 |
| Carpal tunnel release CPT 64721 • Orthopedics | $385 | $480 | $576 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $112 | $163 | $205 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $12 | $176 | $284 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $132 | $132 | $132 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $230 | $293 | $357 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $394 | $469 | $596 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $60 | $60 | $60 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $31 | $49 | $66 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $112 | $153 | $194 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $92 | $103 | $114 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $196 | $221 | $234 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $76 | $94 | $108 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $151 | $175 | $199 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $250 | $704 | $1,376 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $9 | $53 | $81 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $14 | $14 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $40 | $40 | $40 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $37 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $9 | $18 | $22 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $37 | $37 | $37 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $52 | $139 | $226 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $494 | $494 | $494 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $30 | $30 | $30 |
| Special stain group II CPT 88313 • Pathology | $57 | $71 | $85 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $46 | $52 |
| Frozen section pathology each additional CPT 88332 • Pathology | $14 | $14 | $14 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $39 | $59 | $71 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $42 | $42 | $42 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $75 | $107 | $139 |
| Microdissection manual CPT 88381 • Pathology | $215 | $225 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $7 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $11 | $19 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $29 | $42 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $14 | $21 | $36 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $25 | $29 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $31 | $43 | $61 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $14 | $32 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $35 | $55 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $13 | $24 | $34 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $26 | $38 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $73 | $95 | $117 |