| Discectomy lumbar single level CPT 63030 • Orthopedics | $769 | $769 | $769 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $876 | $876 | $876 |
| Carpal tunnel release CPT 64721 • Orthopedics | $346 | $346 | $346 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $41 | $41 | $41 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $219 | $219 | $219 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $215 | $215 | $215 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $41 | $41 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $41 | $41 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $40 | $40 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $207 | $207 | $207 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $41 | $41 | $41 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $149 | $149 | $149 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $74 | $74 | $74 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $115 | $115 | $115 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $384 | $384 | $384 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $163 | $163 | $163 |
| Cytopathology concentration technique CPT 88108 • Pathology | $67 | $67 | $67 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $91 | $91 | $91 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $25 | $25 | $25 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $31 | $31 | $31 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $48 | $48 | $48 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $56 | $56 | $56 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $203 | $203 | $204 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $307 | $307 | $307 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $96 | $96 | $96 |
| Special stain group II CPT 88313 • Pathology | $70 | $70 | $70 |
| Frozen section pathology each additional CPT 88332 • Pathology | $35 | $35 | $35 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $61 | $61 | $61 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $93 | $93 | $93 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $64 | $64 | $64 |
| Microdissection manual CPT 88381 • Pathology | $166 | $166 | $166 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $9 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $14 | $14 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $13 | $13 | $13 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $14 | $14 | $14 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $14 | $14 | $14 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $14 | $14 | $14 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $24 | $24 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $14 | $14 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $13 | $13 | $13 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $60 | $60 | $60 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $60 | $60 | $60 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $42 | $42 | $42 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $25 | $25 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $14 | $14 | $14 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $14 | $14 | $14 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $14 | $14 | $14 |