| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $2,838 | $2,838 | $2,838 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $2,492 | $2,492 | $2,492 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $3,018 | $3,018 | $3,018 |
| Carpal tunnel release CPT 64721 • Orthopedics | $1,226 | $1,226 | $1,226 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $472 | $472 | $472 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $716 | $716 | $716 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $380 | $380 | $380 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $705 | $705 | $705 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $6,247 | $6,247 | $6,247 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $205 | $241 | $277 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $137 | $137 | $137 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $672 | $672 | $672 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $306 | $306 | $306 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $482 | $482 | $482 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $248 | $248 | $248 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $418 | $418 | $418 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $1,207 | $1,207 | $1,207 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $658 | $658 | $658 |
| Cytopathology concentration technique CPT 88108 • Pathology | $72 | $98 | $124 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $103 | $107 | $112 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $28 | $47 | $66 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $16 | $34 | $52 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $48 | $80 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $19 | $42 | $64 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $30 | $62 | $94 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $48 | $61 | $73 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $33 | $47 | $61 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $98 | $102 | $105 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $210 | $400 | $589 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $316 | $783 | $1,250 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $98 | $209 | $320 |
| Special stain group II CPT 88313 • Pathology | $71 | $151 | $232 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $62 | $89 | $116 |
| Frozen section pathology each additional CPT 88332 • Pathology | $41 | $55 | $70 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $81 | $81 | $81 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $99 | $100 | $100 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $64 | $201 | $338 |
| Microdissection manual CPT 88381 • Pathology | $69 | $141 | $212 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $12 | $12 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $24 | $24 | $24 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $23 | $23 | $23 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $28 | $29 | $31 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $28 | $28 | $28 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $57 | $57 | $57 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $66 | $66 | $66 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $57 | $57 | $57 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $53 | $53 | $53 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $35 | $35 | $35 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $196 | $196 | $196 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $196 | $196 | $196 |