| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,389 | $1,389 | $1,389 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,348 | $1,658 | $1,967 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,986 | $2,746 | $3,131 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $2,435 | $3,551 |
| Carpal tunnel release CPT 64721 • Orthopedics | $528 | $649 | $843 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $170 | $254 | $321 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $265 | $284 | $303 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $291 | $372 | $452 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $112 | $477 | $840 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $1,512 | $2,600 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $61 | $92 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $91 | $157 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $160 | $391 | $565 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $88 | $133 | $175 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $170 | $236 | $351 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $60 | $126 | $181 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $199 | $327 | $456 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $250 | $406 | $511 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $197 | $278 |
| Cytopathology concentration technique CPT 88108 • Pathology | $74 | $78 | $81 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $51 | $84 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $28 | $29 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $14 | $18 | $21 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $35 | $43 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $19 | $28 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $28 | $34 | $40 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $30 | $41 | $52 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $190 | $256 | $361 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $414 | $482 | $550 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $89 | $116 | $142 |
| Special stain group II CPT 88313 • Pathology | $50 | $71 | $102 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $61 | $70 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $12 | $40 | $69 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $21 | $68 | $112 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $61 | $94 | $128 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $54 | $103 | $153 |
| Microdissection manual CPT 88381 • Pathology | $98 | $181 | $263 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $10 | $12 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $26 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $28 | $34 | $42 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $31 | $37 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $27 | $34 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $37 | $60 | $71 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $35 | $55 | $82 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $30 | $48 | $71 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $34 | $55 | $67 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $27 | $35 | $42 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $115 | $170 | $241 |