| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $463 | $463 | $463 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $807 | $807 | $807 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $648 | $871 | $1,093 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $736 | $988 | $1,240 |
| Carpal tunnel release CPT 64721 • Orthopedics | $291 | $390 | $489 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $107 | $151 | $174 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $88 | $217 | $293 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $53 | $106 | $159 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $169 | $229 | $288 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,523 | $1,523 | $1,523 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $44 | $52 | $60 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $32 | $43 | $54 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $193 | $231 | $270 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $85 | $85 | $85 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $135 | $165 | $194 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $35 | $77 | $100 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $103 | $137 | $170 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $411 | $447 | $468 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $113 | $187 | $260 |
| Cytopathology concentration technique CPT 88108 • Pathology | $41 | $47 | $54 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $32 | $45 | $58 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $19 | $19 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $12 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $21 | $25 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $19 | $20 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $28 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $27 | $29 | $30 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $9 | $22 | $36 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $25 | $44 | $63 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $47 | $185 | $260 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $91 | $235 | $379 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $56 | $96 |
| Special stain group II CPT 88313 • Pathology | $31 | $47 | $68 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $36 | $36 | $36 |
| Frozen section pathology each additional CPT 88332 • Pathology | $33 | $41 | $48 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $54 | $67 | $80 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $42 | $66 | $91 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $54 | $81 | $108 |
| Microdissection manual CPT 88381 • Pathology | $19 | $95 | $172 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $7 | $8 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $11 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $22 | $23 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $25 | $27 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $22 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $21 | $21 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $14 | $15 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $60 | $67 | $75 |