| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $278 | $278 | $278 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $301 | $301 | $301 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $432 | $432 | $432 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $418 | $418 | $418 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $478 | $478 | $478 |
| Carpal tunnel release CPT 64721 • Orthopedics | $180 | $180 | $180 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $32 | $32 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $117 | $117 | $117 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $74 | $74 | $74 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $48 | $48 | $48 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $625 | $625 | $625 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $44 | $44 | $44 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $18 | $18 | $18 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $48 | $48 | $48 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $75 | $75 | $75 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $24 | $24 | $24 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $63 | $63 | $63 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $113 | $113 | $113 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $91 | $91 | $91 |
| Cytopathology concentration technique CPT 88108 • Pathology | $12 | $12 | $12 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $46 | $46 | $46 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $7 | $7 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $17 | $17 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $13 | $13 | $13 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $5 | $5 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $96 | $96 | $96 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $63 | $63 | $63 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $45 | $45 | $45 |
| Special stain group II CPT 88313 • Pathology | $5 | $5 | $5 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $27 | $27 |
| Frozen section pathology each additional CPT 88332 • Pathology | $13 | $13 | $13 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $10 | $10 | $10 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $45 | $45 | $45 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $54 | $54 | $54 |
| Microdissection manual CPT 88381 • Pathology | $26 | $26 | $26 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $2 | $2 | $2 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $6 | $6 | $6 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $7 | $7 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $8 | $8 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $5 | $5 | $5 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $13 | $13 | $13 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $14 | $14 | $14 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $12 | $12 | $12 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $12 | $12 | $12 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $8 | $8 | $8 |