| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $502 | $502 | $502 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $995 | $995 | $995 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,130 | $1,130 | $1,130 |
| Carpal tunnel release CPT 64721 • Orthopedics | $452 | $452 | $452 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $110 | $110 | $110 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $116 | $179 | $242 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $215 | $243 | $271 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $921 | $921 | $921 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $86 | $86 | $86 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $44 | $47 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $238 | $293 | $348 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $155 | $155 | $155 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $167 | $177 | $187 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $92 | $109 | $127 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $147 | $147 | $147 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $448 | $448 | $448 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $62 | $62 | $62 |
| Cytopathology concentration technique CPT 88108 • Pathology | $67 | $67 | $67 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $31 | $40 | $50 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $18 | $24 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $10 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $12 | $18 | $25 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $19 | $28 | $36 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $33 | $33 | $33 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $242 | $242 | $242 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $366 | $366 | $366 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $39 | $58 | $77 |
| Special stain group II CPT 88313 • Pathology | $32 | $43 | $54 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $31 | $31 |
| Frozen section pathology each additional CPT 88332 • Pathology | $34 | $34 | $34 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $44 | $48 | $53 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $51 | $61 | $70 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $65 | $65 | $65 |
| Microdissection manual CPT 88381 • Pathology | $98 | $98 | $98 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $12 | $12 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $11 | $14 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $14 | $14 | $14 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $10 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $23 | $24 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $25 | $25 | $25 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $21 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $21 | $22 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $13 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $60 | $68 | $75 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $60 | $68 | $76 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $46 | $49 | $52 |