| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $613 | $613 | $613 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $609 | $609 | $609 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $176 | $433 | $691 |
| Carpal tunnel release CPT 64721 • Orthopedics | $272 | $356 | $440 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $116 | $116 | $116 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $67 | $67 | $67 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $61 | $61 | $61 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $158 | $158 | $158 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,173 | $1,173 | $1,173 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $79 | $84 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $22 | $22 | $22 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $211 | $211 | $211 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $64 | $64 | $64 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $56 | $56 | $56 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $38 | $38 | $38 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $228 | $228 | $228 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $419 | $419 | $419 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $37 | $37 | $37 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $25 | $37 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $39 | $40 | $41 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $19 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $18 | $18 | $19 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $14 | $15 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $24 | $27 | $29 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $23 | $39 | $55 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $117 | $231 | $412 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $90 | $169 | $248 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $58 | $59 | $61 |
| Special stain group II CPT 88313 • Pathology | $9 | $36 | $54 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $49 | $60 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $26 | $33 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $18 | $37 | $56 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $64 | $64 | $65 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $32 | $45 | $58 |
| Microdissection manual CPT 88381 • Pathology | $92 | $101 | $110 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $18 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $15 | $22 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $18 | $27 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $19 | $26 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $42 | $60 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $40 | $69 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $35 | $60 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $30 | $49 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $11 | $11 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $61 | $137 | $200 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $61 | $115 | $200 |