| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,323 | $1,323 | $1,323 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,498 | $1,498 | $1,498 |
| Carpal tunnel release CPT 64721 • Orthopedics | $607 | $607 | $607 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $50 | $50 | $50 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $282 | $323 | $365 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $360 | $360 | $360 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $137 | $143 | $148 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $39 | $39 | $39 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $343 | $343 | $343 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $38 | $38 | $38 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $241 | $241 | $241 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $98 | $98 | $98 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $209 | $209 | $209 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $368 | $492 | $617 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $204 | $204 | $204 |
| Cytopathology concentration technique CPT 88108 • Pathology | $40 | $40 | $40 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $41 | $41 | $41 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $17 | $17 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $26 | $26 | $26 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $173 | $176 | $178 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $270 | $270 | $270 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $69 | $69 | $69 |
| Special stain group II CPT 88313 • Pathology | $50 | $50 | $50 |
| Frozen section pathology each additional CPT 88332 • Pathology | $34 | $34 | $34 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $53 | $53 | $53 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $61 | $61 | $61 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $47 | $47 | $47 |
| Microdissection manual CPT 88381 • Pathology | $123 | $123 | $123 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $6 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $12 | $12 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $11 | $11 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $14 | $14 | $14 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $13 | $13 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $40 | $40 | $40 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $33 | $33 | $33 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $28 | $28 | $28 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $26 | $26 | $26 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $17 | $17 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $98 | $98 | $98 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $98 | $98 | $98 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $67 | $68 | $69 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $36 | $36 | $36 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $32 | $32 | $32 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $31 | $31 | $31 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $33 | $33 | $33 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $47 | $47 | $47 |