| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $673 | $673 | $673 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $699 | $699 | $699 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,041 | $1,041 | $1,041 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $141 | $141 | $141 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,124 | $1,124 | $1,124 |
| Carpal tunnel release CPT 64721 • Orthopedics | $457 | $457 | $457 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $110 | $110 | $110 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $242 | $242 | $242 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $215 | $215 | $215 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $357 | $357 | $357 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $21 | $21 | $21 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $44 | $44 | $44 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $232 | $232 | $232 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $103 | $103 | $103 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $167 | $167 | $167 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $126 | $126 | $126 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $139 | $139 | $139 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $304 | $304 | $304 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $94 | $94 | $94 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $31 | $31 | $31 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $13 | $13 |
| 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 | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $37 | $37 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $230 | $230 | $230 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $39 | $39 | $39 |
| Special stain group II CPT 88313 • Pathology | $37 | $37 | $37 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $56 | $56 | $56 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $17 | $17 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $31 | $31 | $31 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $42 | $42 | $42 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $64 | $64 | $64 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $12 | $12 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $9 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $11 | $11 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $22 | $22 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $25 | $25 | $25 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $26 | $26 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $24 | $24 |