| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $30 | $30 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $473 | $915 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,107 | $1,107 | $1,107 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $236 | $442 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $30 | $30 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $210 | $234 | $258 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $254 | $254 | $255 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $247 | $463 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $35 | $39 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $49 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $241 | $241 | $241 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $172 | $172 | $172 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $88 | $89 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $152 | $154 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $433 | $451 | $468 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $240 | $250 | $260 |
| Cytopathology concentration technique CPT 88108 • Pathology | $49 | $51 | $53 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $53 | $53 | $53 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $18 | $18 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $20 | $21 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $26 | $26 | $26 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $34 | $34 | $34 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $233 | $247 | $260 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $351 | $351 | $351 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $90 | $90 | $90 |
| Special stain group II CPT 88313 • Pathology | $62 | $64 | $66 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $79 | $79 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $43 | $43 | $43 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $68 | $68 | $69 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $77 | $79 | $80 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $93 | $93 | $94 |
| Microdissection manual CPT 88381 • Pathology | $163 | $163 | $163 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $10 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $9 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $11 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $11 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $21 | $21 | $21 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $22 | $22 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $21 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $22 | $22 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $13 | $13 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $74 | $74 | $74 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $84 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $50 | $50 | $50 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $55 | $56 | $57 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $30 | $30 |