| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $623 | $623 | $623 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $600 | $600 | $600 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $764 | $764 | $764 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,077 | $1,077 | $1,077 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $141 | $428 | $1,001 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,213 | $1,213 | $1,213 |
| Carpal tunnel release CPT 64721 • Orthopedics | $484 | $484 | $484 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $157 | $165 | $179 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $288 | $288 | $288 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $153 | $153 | $153 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $283 | $283 | $283 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $458 | $458 | $458 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $46 | $46 | $46 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $55 | $55 | $55 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $232 | $271 | $309 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $103 | $110 | $123 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $100 | $184 | $225 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $57 | $103 | $126 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $134 | $134 | $134 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $212 | $212 | $212 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $264 | $264 | $264 |
| Cytopathology concentration technique CPT 88108 • Pathology | $41 | $41 | $41 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $13 | $21 | $37 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $22 | $22 | $22 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $25 | $25 | $25 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $5 | $5 | $5 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $31 | $31 | $31 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $31 | $31 | $31 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $13 | $29 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $16 | $22 | $33 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $116 | $275 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $416 | $416 | $416 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $12 | $47 | $81 |
| Special stain group II CPT 88313 • Pathology | $5 | $26 | $66 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $98 | $98 | $98 |
| Frozen section pathology each additional CPT 88332 • Pathology | $29 | $29 | $29 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $18 | $27 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $42 | $95 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $113 | $113 | $113 |
| Microdissection manual CPT 88381 • Pathology | $23 | $23 | $23 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $10 | $12 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $11 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $22 | $24 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $24 | $28 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $22 | $24 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $20 | $22 |