| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $389 | $602 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $798 | $1,784 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $660 | $1,771 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $547 | $889 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $454 | $779 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $125 | $272 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $121 | $196 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $116 | $116 | $116 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $248 | $287 | $357 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $1,623 | $4,242 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $15 | $76 | $136 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $70 | $118 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $194 | $287 | $424 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $92 | $186 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $141 | $182 | $234 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $102 | $121 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $208 | $272 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $221 | $303 | $437 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $178 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $24 | $38 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $37 | $43 | $49 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $32 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $37 | $54 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $12 | $17 | $22 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $20 | $23 | $25 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $43 | $65 | $87 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $183 | $231 | $291 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $260 | $350 | $441 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $48 | $48 |
| Special stain group II CPT 88313 • Pathology | $12 | $32 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $30 | $71 | $110 |
| Frozen section pathology each additional CPT 88332 • Pathology | $18 | $36 | $55 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $69 | $87 | $112 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $54 | $76 | $97 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $32 | $63 | $95 |
| Microdissection manual CPT 88381 • Pathology | $45 | $125 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $9 | $13 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $18 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $17 | $31 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $23 | $36 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $15 | $22 | $27 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $32 | $43 | $61 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $36 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $29 | $37 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $26 | $34 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $26 | $38 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $65 | $91 | $117 |