| Carpal tunnel release CPT 64721 • Orthopedics | $1,052 | $1,052 | $1,052 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $201 | $294 | $388 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $346 | $482 | $618 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $263 | $311 | $360 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $611 | $725 | $840 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $4,508 | $6,029 | $7,550 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $183 | $183 | $183 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $118 | $118 | $118 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $274 | $274 | $274 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $249 | $249 | $249 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $221 | $221 | $221 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $214 | $214 | $214 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $359 | $359 | $359 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $544 | $544 | $544 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $408 | $408 | $408 |
| Cytopathology concentration technique CPT 88108 • Pathology | $36 | $59 | $81 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $22 | $53 | $84 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $22 | $28 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $15 | $21 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $26 | $35 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $21 | $28 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $31 | $43 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $29 | $40 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $24 | $38 | $52 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $23 | $57 | $91 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $206 | $361 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $153 | $352 | $550 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $61 | $101 | $142 |
| Special stain group II CPT 88313 • Pathology | $36 | $69 | $102 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $58 | $94 | $131 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $44 | $69 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $53 | $82 | $112 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $61 | $94 | $128 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $46 | $100 | $153 |
| Microdissection manual CPT 88381 • Pathology | $15 | $139 | $263 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $10 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $14 | $22 | $30 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $12 | $20 | $28 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $15 | $25 | $35 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $14 | $24 | $34 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $30 | $50 | $71 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $35 | $58 | $82 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $30 | $50 | $71 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $28 | $46 | $65 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $18 | $30 | $42 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $84 | $162 | $241 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $162 | $241 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $84 | $162 | $241 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $58 | $112 | $165 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $39 | $64 | $89 |