| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $357 | $685 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $651 | $966 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $833 | $1,522 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,081 | $1,403 | $1,725 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $379 | $690 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $57 | $84 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $169 | $237 | $303 |
| 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 | $234 | $315 | $413 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $653 | $1,275 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $21 | $62 | $121 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $47 | $54 | $59 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $212 | $299 | $386 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $41 | $52 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $167 | $222 | $277 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $84 | $111 | $143 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $139 | $185 | $238 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $223 | $512 | $656 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $167 | $226 | $271 |
| Cytopathology concentration technique CPT 88108 • Pathology | $28 | $41 | $48 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $24 | $37 | $49 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $17 | $19 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $12 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $4 | $15 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $14 | $16 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $19 | $22 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $14 | $19 | $23 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $35 | $63 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $23 | $39 | $54 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $157 | $211 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $90 | $205 | $319 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $56 | $68 | $81 |
| Special stain group II CPT 88313 • Pathology | $39 | $52 | $59 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $18 | $48 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $11 | $47 | $84 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $35 | $54 | $63 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $61 | $70 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $36 | $70 | $86 |
| Microdissection manual CPT 88381 • Pathology | $67 | $106 | $145 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $11 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $12 | $18 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $14 | $19 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $11 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $26 | $31 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $30 | $33 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $25 | $28 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $25 | $29 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $14 | $17 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $70 | $74 | $78 |