| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $451 | $502 | $594 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $755 | $755 | $755 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,072 | $1,072 | $1,072 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $727 | $884 | $1,041 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $883 | $1,035 | $1,187 |
| Carpal tunnel release CPT 64721 • Orthopedics | $351 | $405 | $459 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $134 | $160 | $186 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $118 | $160 | $202 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $64 | $79 | $95 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $198 | $226 | $255 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,410 | $1,410 | $1,410 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $115 | $115 | $115 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $39 | $46 | $53 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $123 | $156 | $189 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $41 | $75 | $109 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $103 | $119 | $136 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $58 | $64 | $70 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $121 | $137 | $153 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $340 | $389 | $482 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $145 | $184 |
| Cytopathology concentration technique CPT 88108 • Pathology | $27 | $37 | $47 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $33 | $40 | $48 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $11 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $22 | $22 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $17 | $20 | $24 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $23 | $27 | $31 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $35 | $37 | $40 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $39 | $54 | $70 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $86 | $165 | $207 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $201 | $258 | $314 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $15 | $34 | $53 |
| Special stain group II CPT 88313 • Pathology | $30 | $36 | $38 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $34 | $40 | $46 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $29 | $40 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $12 | $35 | $46 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $24 | $39 | $61 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $57 | $85 |
| Microdissection manual CPT 88381 • Pathology | $61 | $102 | $142 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $11 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $12 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $13 | $18 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $10 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $24 | $29 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $26 | $31 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $23 | $26 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $23 | $27 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $15 | $19 |