| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $2,267 | $2,267 | $2,267 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,348 | $2,279 | $3,209 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $180 | $688 | $1,195 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $1,878 | $3,551 |
| Carpal tunnel release CPT 64721 • Orthopedics | $576 | $971 | $1,367 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $173 | $227 | $280 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $167 | $225 | $284 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $502 | $502 | $502 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $357 | $570 | $782 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $985 | $1,375 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $257 | $257 | $257 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $66 | $69 | $72 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $194 | $284 | $375 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $88 | $90 | $91 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $106 | $229 | $351 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $121 | $201 | $282 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $199 | $327 | $456 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $318 | $847 | $1,376 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $318 | $569 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $14 | $14 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $32 | $32 | $32 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $30 | $30 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $35 | $47 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $10 | $10 | $10 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $7 | $7 | $7 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $67 | $67 | $67 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $39 | $39 | $39 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $65 | $65 | $65 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $62 | $62 | $62 |
| Special stain group II CPT 88313 • Pathology | $29 | $29 | $29 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $95 | $95 | $95 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $42 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $43 | $61 | $71 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $54 | $54 | $54 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $27 | $27 | $27 |
| Microdissection manual CPT 88381 • Pathology | $98 | $167 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $8 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $15 | $24 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $30 | $34 | $42 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $33 | $43 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $25 | $29 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $37 | $56 | $71 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $47 | $62 | $74 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $37 | $52 | $63 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $26 | $39 | $58 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $38 | $38 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $80 | $98 | $117 |