| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $723 | $723 | $723 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,015 | $1,015 | $1,015 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $953 | $953 | $953 |
| Carpal tunnel release CPT 64721 • Orthopedics | $469 | $469 | $469 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $173 | $173 | $173 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $278 | $278 | $278 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $275 | $275 | $275 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,496 | $2,496 | $2,496 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $78 | $78 | $78 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $51 | $51 | $51 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $118 | $118 | $118 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $94 | $94 | $94 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $161 | $161 | $161 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $560 | $560 | $560 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $236 | $236 | $236 |
| Cytopathology concentration technique CPT 88108 • Pathology | $22 | $27 | $36 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $34 | $45 | $55 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $12 | $15 | $18 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $10 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $25 | $27 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $20 | $23 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $16 | $17 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $24 | $26 | $28 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $6 | $22 | $37 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $36 | $45 | $55 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $47 | $142 | $189 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $67 | $148 | $230 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $42 | $51 | $60 |
| Special stain group II CPT 88313 • Pathology | $23 | $34 | $42 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $48 | $53 | $59 |
| Frozen section pathology each additional CPT 88332 • Pathology | $22 | $23 | $24 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $22 | $40 | $55 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $25 | $48 | $65 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $42 | $55 | $64 |
| Microdissection manual CPT 88381 • Pathology | $92 | $102 | $112 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $6 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $10 | $10 |
| 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 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $20 | $20 | $20 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $23 | $23 | $23 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $18 | $18 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $60 | $60 | $60 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $66 | $66 | $66 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $21 | $21 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $21 | $21 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $31 | $31 | $31 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $33 | $33 | $33 |