| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $682 | $682 | $682 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $21 | $492 | $963 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $944 | $963 | $981 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,071 | $1,092 | $1,112 |
| Carpal tunnel release CPT 64721 • Orthopedics | $422 | $429 | $437 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $156 | $163 | $170 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $245 | $251 | $257 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $85 | $85 | $85 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $242 | $247 | $253 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $409 | $409 | $409 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $75 | $75 | $75 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $47 | $47 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $220 | $230 | $241 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $95 | $95 | $95 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $167 | $168 | $169 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $85 | $87 | $88 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $120 | $137 | $154 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $220 | $363 | $435 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $59 | $150 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $41 | $58 | $75 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $26 | $52 | $78 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $22 | $24 | $26 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $14 | $18 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $25 | $30 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $20 | $24 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $23 | $36 | $49 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $16 | $26 | $37 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $8 | $28 | $48 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $27 | $35 | $43 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $181 | $284 | $336 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $275 | $392 | $509 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $90 | $132 |
| Special stain group II CPT 88313 • Pathology | $48 | $68 | $95 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $45 | $62 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $36 | $50 | $63 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $42 | $71 | $103 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $46 | $81 | $118 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $47 | $63 |
| Microdissection manual CPT 88381 • Pathology | $85 | $165 | $246 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $6 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $11 | $13 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $12 | $12 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $14 | $15 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $13 | $14 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $29 | $30 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $31 | $33 | $34 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $27 | $28 | $30 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $25 | $26 | $27 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $17 | $18 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $83 | $88 | $93 |