| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,148 | $1,148 | $1,148 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,068 | $1,068 | $1,068 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,289 | $1,289 | $1,289 |
| Carpal tunnel release CPT 64721 • Orthopedics | $519 | $519 | $519 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $193 | $193 | $193 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $308 | $308 | $308 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $159 | $159 | $159 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $303 | $303 | $303 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $492 | $492 | $492 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $88 | $88 | $88 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $59 | $59 | $59 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $289 | $289 | $289 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $131 | $131 | $131 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $208 | $208 | $208 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $107 | $107 | $107 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $141 | $141 | $141 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $518 | $518 | $518 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $280 | $280 | $280 |
| Cytopathology concentration technique CPT 88108 • Pathology | $26 | $26 | $26 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $16 | $16 | $16 |
| 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 | $16 | $16 | $16 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $19 | $19 | $19 |
| 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 | $6 | $6 | $6 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $41 | $41 | $41 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $46 | $46 | $46 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $163 | $163 | $163 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $48 | $48 |
| Special stain group II CPT 88313 • Pathology | $40 | $40 | $40 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $35 | $35 | $35 |
| Frozen section pathology each additional CPT 88332 • Pathology | $14 | $14 | $14 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $51 | $51 | $51 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $60 | $60 | $60 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $68 | $68 | $68 |
| Microdissection manual CPT 88381 • Pathology | $112 | $112 | $112 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $11 | $11 | $11 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $21 | $25 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $14 | $19 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $25 | $35 | $44 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $29 | $38 | $46 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $25 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $23 | $23 | $23 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $16 | $16 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $87 | $87 | $87 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $80 | $82 | $87 |