| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $724 | $1,495 | $2,267 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $204 | $1,587 | $3,209 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $831 | $1,615 | $3,121 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $1,616 | $3,551 |
| Carpal tunnel release CPT 64721 • Orthopedics | $253 | $677 | $1,376 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $192 | $523 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $216 | $432 | $797 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $180 | $235 | $291 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $12 | $297 | $782 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $1,997 | $4,242 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $9 | $103 | $257 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $29 | $67 | $118 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $13 | $309 | $713 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $12 | $107 | $285 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $78 | $297 | $561 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $99 | $120 | $174 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $23 | $213 | $456 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $128 | $558 | $1,376 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $7 | $211 | $569 |
| Cytopathology concentration technique CPT 88108 • Pathology | $45 | $48 | $52 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $32 | $45 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $4 | $18 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $10 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $4 | $29 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $17 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $19 | $23 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $11 | $20 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $11 | $21 | $29 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $22 | $30 | $37 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $39 | $105 | $195 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $296 | $336 | $414 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $56 | $89 |
| Special stain group II CPT 88313 • Pathology | $12 | $30 | $43 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $47 | $61 |
| Frozen section pathology each additional CPT 88332 • Pathology | $12 | $25 | $31 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $17 | $31 | $56 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $40 | $67 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $75 | $91 | $123 |
| Microdissection manual CPT 88381 • Pathology | $59 | $77 | $98 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $7 | $13 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $24 | $35 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $22 | $42 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $21 | $43 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $15 | $29 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $48 | $71 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $20 | $41 | $74 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $16 | $33 | $63 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $44 | $67 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $29 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $25 | $93 | $180 |