| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,730 | $1,730 | $1,730 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,388 | $1,388 | $1,388 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,838 | $1,838 | $1,838 |
| Carpal tunnel release CPT 64721 • Orthopedics | $612 | $612 | $612 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $344 | $344 | $344 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $208 | $208 | $208 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $216 | $216 | $216 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $413 | $413 | $413 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,445 | $2,445 | $2,445 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $151 | $151 | $151 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $88 | $88 | $88 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $348 | $348 | $348 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $118 | $118 | $118 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $486 | $486 | $486 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $129 | $129 | $129 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $260 | $260 | $260 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $780 | $780 | $780 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $87 | $87 | $87 |
| Cytopathology concentration technique CPT 88108 • Pathology | $52 | $71 | $90 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $46 | $48 | $51 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $25 | $32 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $14 | $18 | $21 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $34 | $46 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $30 | $43 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $24 | $25 | $26 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $32 | $46 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $17 | $21 | $24 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $42 | $51 | $59 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $129 | $145 | $162 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $179 | $211 | $244 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $63 | $77 |
| Special stain group II CPT 88313 • Pathology | $9 | $28 | $46 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $60 | $76 | $92 |
| Frozen section pathology each additional CPT 88332 • Pathology | $33 | $37 | $41 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $17 | $43 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $54 | $57 | $60 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $59 | $79 | $99 |
| Microdissection manual CPT 88381 • Pathology | $150 | $209 | $269 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $6 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $19 | $19 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $19 | $19 | $19 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $22 | $22 | $22 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $17 | $17 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $41 | $41 | $41 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $41 | $41 | $41 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $34 | $34 | $34 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $37 | $37 | $37 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $24 | $24 | $24 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $119 | $119 | $119 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $119 | $119 | $119 |