| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,529 | $1,529 | $1,529 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,324 | $1,739 | $2,155 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,979 | $1,982 | $1,986 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,503 | $1,878 | $2,253 |
| Carpal tunnel release CPT 64721 • Orthopedics | $586 | $718 | $849 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $183 | $256 | $329 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $224 | $254 | $284 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $179 | $179 | $179 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $112 | $158 | $204 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $1,560 | $2,525 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $156 | $156 | $156 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $66 | $81 | $95 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $126 | $274 | $423 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $59 | $115 | $171 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $183 | $209 | $234 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $169 | $175 | $181 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $199 | $228 | $256 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $318 | $562 | $806 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $94 | $121 |
| Cytopathology concentration technique CPT 88108 • Pathology | $23 | $23 | $23 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $65 | $65 | $65 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $32 | $32 | $32 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $31 | $44 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $29 | $29 | $29 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $32 | $32 | $32 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $253 | $253 | $253 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $237 | $237 | $237 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $66 | $66 | $66 |
| Special stain group II CPT 88313 • Pathology | $12 | $12 | $12 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $30 | $30 | $30 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $19 | $19 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $57 | $65 | $71 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $65 | $65 | $65 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $78 | $78 | $78 |
| Microdissection manual CPT 88381 • Pathology | $89 | $162 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $8 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $24 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $16 | $26 | $31 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $16 | $26 | $36 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $20 | $27 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $42 | $61 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $47 | $64 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $23 | $42 | $55 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $25 | $39 | $58 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $26 | $38 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $68 | $92 | $117 |