| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,430 | $1,430 | $1,430 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $2,029 | $2,029 | $2,029 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,172 | $1,582 | $1,992 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,344 | $1,972 | $2,601 |
| Carpal tunnel release CPT 64721 • Orthopedics | $520 | $774 | $1,028 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $159 | $244 | $330 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $604 | $604 | $604 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $92 | $199 | $306 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $349 | $473 | $597 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $62 | $1,947 | $3,832 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $103 | $103 | $103 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $67 | $84 | $100 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $398 | $475 | $552 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $212 | $212 | $212 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $187 | $206 | $224 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $105 | $134 | $182 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $193 | $249 | $306 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $44 | $503 | $845 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $125 | $232 | $285 |
| Cytopathology concentration technique CPT 88108 • Pathology | $22 | $45 | $68 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $44 | $70 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $19 | $24 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $17 | $25 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $23 | $29 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $8 | $15 | $24 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $28 | $36 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $19 | $33 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $17 | $30 | $44 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $190 | $301 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $153 | $306 | $458 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $61 | $89 | $118 |
| Special stain group II CPT 88313 • Pathology | $7 | $46 | $85 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $20 | $33 | $47 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $38 | $58 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $36 | $65 | $93 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $64 | $106 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $43 | $60 |
| Microdissection manual CPT 88381 • Pathology | $87 | $154 | $220 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $11 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $9 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $11 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $10 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $30 | $37 | $43 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $16 | $23 | $30 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $17 | $23 | $30 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $24 | $32 | $40 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $13 | $15 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $72 | $110 | $148 |