| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $761 | $925 | $1,089 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,073 | $1,073 | $1,073 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,067 | $1,067 | $1,067 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,210 | $1,210 | $1,210 |
| Carpal tunnel release CPT 64721 • Orthopedics | $466 | $466 | $466 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $173 | $242 | $311 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $91 | $200 | $272 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $123 | $144 | $165 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $269 | $269 | $269 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,740 | $1,740 | $1,740 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $66 | $74 | $83 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $51 | $51 | $51 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $244 | $244 | $244 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $106 | $157 | $209 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $186 | $186 | $186 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $44 | $69 | $94 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $162 | $162 | $162 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $445 | $636 | $827 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $184 | $373 | $487 |
| Cytopathology concentration technique CPT 88108 • Pathology | $23 | $23 | $23 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $18 | $18 | $18 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $19 | $19 | $19 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $18 | $18 | $18 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $20 | $20 |
| 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 | $25 | $25 | $25 |
| 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 | $52 | $275 | $498 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $92 | $92 | $92 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $61 | $61 | $61 |
| Special stain group II CPT 88313 • Pathology | $13 | $25 | $37 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $39 | $39 |
| Frozen section pathology each additional CPT 88332 • Pathology | $33 | $33 | $33 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $57 | $57 | $57 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $43 | $43 | $43 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $49 | $50 | $51 |
| Microdissection manual CPT 88381 • Pathology | $78 | $105 | $131 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $2 | $3 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $18 | $22 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $5 | $8 | $11 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $6 | $9 | $13 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $6 | $9 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $27 | $28 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $16 | $23 | $30 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $20 | $26 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $24 | $25 | $26 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $8 | $12 | $16 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $74 | $74 | $74 |