| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $814 | $814 | $814 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $768 | $768 | $768 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $880 | $880 | $880 |
| Carpal tunnel release CPT 64721 • Orthopedics | $339 | $339 | $339 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $57 | $57 | $57 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $239 | $239 | $239 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $150 | $150 | $150 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $99 | $99 | $99 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,308 | $1,308 | $1,308 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $86 | $86 | $86 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $47 | $47 | $47 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $259 | $259 | $259 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $126 | $126 | $126 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $223 | $223 | $223 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $86 | $86 | $86 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $140 | $140 | $140 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $443 | $443 | $443 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $185 | $185 | $185 |
| Cytopathology concentration technique CPT 88108 • Pathology | $24 | $24 | $24 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $61 | $61 | $61 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $22 | $22 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $15 | $15 | $15 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $24 | $24 | $24 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $28 | $28 | $28 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $58 | $58 | $58 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $114 | $114 | $114 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $77 | $77 | $77 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $15 | $15 | $15 |
| Special stain group II CPT 88313 • Pathology | $39 | $39 | $39 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $34 | $34 | $34 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $17 | $17 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $14 | $14 | $14 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $30 | $30 | $30 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $31 | $31 | $31 |
| Microdissection manual CPT 88381 • Pathology | $119 | $119 | $119 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $3 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $10 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $11 | $11 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $25 | $25 | $25 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $26 | $26 | $26 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $22 | $22 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $23 | $23 | $23 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $16 | $16 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $78 | $78 | $78 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $78 | $78 | $78 |