| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $2,267 | $2,267 | $2,267 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,324 | $2,266 | $3,209 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,986 | $2,553 | $3,121 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,503 | $2,527 | $3,551 |
| Carpal tunnel release CPT 64721 • Orthopedics | $586 | $981 | $1,376 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $173 | $297 | $523 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $121 | $459 | $797 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $502 | $502 | $502 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $112 | $399 | $782 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $985 | $1,375 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $87 | $119 | $151 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $57 | $94 | $157 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $194 | $285 | $375 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $91 | $188 | $285 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $201 | $332 | $561 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $104 | $189 | $282 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $199 | $327 | $456 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $44 | $556 | $1,376 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $210 | $285 |
| Cytopathology concentration technique CPT 88108 • Pathology | $22 | $36 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $50 | $55 | $60 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $24 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $13 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $38 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $20 | $20 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $28 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $23 | $24 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $30 | $30 | $31 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $28 | $48 | $67 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $190 | $209 | $218 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $331 | $373 | $414 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $85 | $87 | $89 |
| Special stain group II CPT 88313 • Pathology | $50 | $55 | $61 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $78 | $86 | $95 |
| Frozen section pathology each additional CPT 88332 • Pathology | $30 | $36 | $41 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $21 | $53 | $71 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $54 | $65 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $70 | $81 | $92 |
| Microdissection manual CPT 88381 • Pathology | $54 | $145 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $9 | $13 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $23 | $35 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $27 | $42 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $26 | $43 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $25 | $29 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $37 | $56 | $71 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $16 | $46 | $74 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $17 | $43 | $63 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $14 | $38 | $67 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $38 | $38 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $41 | $112 | $180 |