| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,414 | $1,414 | $1,414 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,334 | $1,390 | $1,446 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $233 | $881 | $1,529 |
| Carpal tunnel release CPT 64721 • Orthopedics | $587 | $640 | $693 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $280 | $280 | $280 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $415 | $415 | $415 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $261 | $261 | $261 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $173 | $173 | $173 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $617 | $617 | $617 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $149 | $149 | $149 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $81 | $81 | $81 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $155 | $155 | $155 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $219 | $219 | $219 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $387 | $387 | $387 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $150 | $150 | $150 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $243 | $243 | $243 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $723 | $746 | $770 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $322 | $322 | $322 |
| Cytopathology concentration technique CPT 88108 • Pathology | $42 | $42 | $42 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $75 | $75 | $75 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $38 | $38 | $38 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $24 | $24 | $24 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $58 | $58 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $32 | $32 | $32 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $41 | $41 | $41 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $73 | $73 | $73 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $91 | $91 | $91 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $56 | $56 | $56 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $120 | $276 | $432 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $453 | $453 | $453 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $97 | $97 | $97 |
| Special stain group II CPT 88313 • Pathology | $18 | $18 | $18 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $90 | $90 | $90 |
| Frozen section pathology each additional CPT 88332 • Pathology | $15 | $15 | $15 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $108 | $108 | $108 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $63 | $63 | $63 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $91 | $91 | $91 |
| Microdissection manual CPT 88381 • Pathology | $318 | $318 | $318 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $8 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $15 | $15 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $16 | $16 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $17 | $17 | $17 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $12 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $43 | $46 | $49 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $45 | $45 | $45 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $37 | $37 | $37 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $40 | $41 | $42 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $27 | $27 | $27 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $136 | $151 | $166 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $136 | $151 | $166 |