| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $828 | $1,368 | $1,909 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $803 | $1,370 | $1,937 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $916 | $1,563 | $2,209 |
| Carpal tunnel release CPT 64721 • Orthopedics | $345 | $634 | $850 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $60 | $111 | $142 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $105 | $332 | $467 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $84 | $112 | $140 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $96 | $306 | $461 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $835 | $1,047 | $1,260 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $49 | $90 | $133 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $45 | $70 | $95 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $94 | $262 | $430 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $89 | $128 | $181 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $71 | $205 | $339 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $80 | $126 | $172 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $122 | $218 | $287 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $430 | $622 | $813 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $180 | $257 | $333 |
| Cytopathology concentration technique CPT 88108 • Pathology | $41 | $41 | $41 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $33 | $33 | $33 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $23 | $23 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $19 | $19 | $19 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $4 | $4 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $6 | $6 | $6 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $72 | $72 | $72 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $179 | $179 | $179 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $40 | $40 | $40 |
| Special stain group II CPT 88313 • Pathology | $7 | $7 | $7 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $51 | $51 | $51 |
| Frozen section pathology each additional CPT 88332 • Pathology | $6 | $6 | $6 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $26 | $26 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $32 | $32 | $32 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $37 | $37 | $37 |
| Microdissection manual CPT 88381 • Pathology | $87 | $87 | $87 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $7 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $19 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $22 | $32 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $23 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $15 | $22 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $21 | $38 | $55 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $39 | $57 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $38 | $48 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $35 | $51 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $22 | $30 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $61 | $110 | $159 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $61 | $61 | $61 |