| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $866 | $1,188 | $1,419 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,223 | $1,640 | $2,002 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $192 | $1,438 | $2,031 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,360 | $1,977 | $2,310 |
| Carpal tunnel release CPT 64721 • Orthopedics | $732 | $832 | $908 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $297 | $330 | $364 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $216 | $316 | $420 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $275 | $277 | $280 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $125 | $390 | $520 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $519 | $1,567 | $2,699 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $38 | $82 | $151 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $82 | $95 | $101 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $279 | $448 | $570 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $66 | $189 | $262 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $182 | $285 | $354 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $99 | $152 | $183 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $154 | $253 | $313 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $387 | $679 | $963 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $76 | $338 | $485 |
| Cytopathology concentration technique CPT 88108 • Pathology | $29 | $99 | $132 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $36 | $77 | $140 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $39 | $51 | $68 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $15 | $25 | $35 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $39 | $55 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $31 | $44 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $41 | $58 | $68 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $28 | $52 | $65 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $34 | $60 | $84 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $49 | $72 | $94 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $163 | $386 | $614 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $190 | $634 | $871 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $88 | $153 | $202 |
| Special stain group II CPT 88313 • Pathology | $16 | $103 | $142 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $81 | $114 | $166 |
| Frozen section pathology each additional CPT 88332 • Pathology | $40 | $87 | $110 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $37 | $123 | $187 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $84 | $154 | $220 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $101 | $225 | $325 |
| Microdissection manual CPT 88381 • Pathology | $47 | $108 | $169 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $12 | $13 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $19 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $22 | $33 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $28 | $33 | $40 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $15 | $23 | $28 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $38 | $52 | $68 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $42 | $57 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $34 | $42 | $50 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $32 | $46 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $21 | $30 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $106 | $148 | $170 |