| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,221 | $1,221 | $1,221 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,348 | $2,057 | $2,765 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $180 | $949 | $1,363 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $1,091 | $1,552 |
| Carpal tunnel release CPT 64721 • Orthopedics | $586 | $805 | $1,218 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $175 | $241 | $329 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $121 | $271 | $356 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $115 | $177 | $239 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $112 | $258 | $376 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $32 | $363 | $596 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $131 | $172 | $213 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $64 | $67 | $71 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $239 | $296 | $359 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $59 | $188 | $290 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $187 | $251 | $305 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $71 | $107 | $130 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $203 | $225 | $264 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $250 | $458 | $666 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $176 | $281 |
| Cytopathology concentration technique CPT 88108 • Pathology | $62 | $64 | $65 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $22 | $53 | $84 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $21 | $23 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $14 | $15 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $27 | $38 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $21 | $23 | $24 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $37 | $37 | $37 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $25 | $35 | $44 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $24 | $38 | $52 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $189 | $223 | $291 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $285 | $286 | $286 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $53 | $71 | $89 |
| Special stain group II CPT 88313 • Pathology | $65 | $66 | $67 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $108 | $108 | $108 |
| Frozen section pathology each additional CPT 88332 • Pathology | $7 | $20 | $33 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $17 | $37 | $57 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $86 | $98 | $111 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $102 | $121 | $139 |
| Microdissection manual CPT 88381 • Pathology | $154 | $172 | $190 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $7 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $14 | $19 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $13 | $21 | $29 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $24 | $35 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $14 | $17 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $30 | $37 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $35 | $41 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $21 | $30 | $37 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $29 | $44 | $67 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $16 | $18 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $63 | $88 | $115 |