| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,018 | $1,210 | $1,324 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,134 | $1,252 | $1,324 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $838 | $1,472 |
| Carpal tunnel release CPT 64721 • Orthopedics | $543 | $572 | $598 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $170 | $181 | $191 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $121 | $217 | $313 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $181 | $181 | $181 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $310 | $334 | $357 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $1,243 | $1,891 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $93 | $93 | $93 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $66 | $67 | $68 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $146 | $202 | $259 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $92 | $114 | $137 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $187 | $206 | $224 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $62 | $122 | $181 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $166 | $183 | $199 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $250 | $375 | $500 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $72 | $79 | $86 |
| Cytopathology concentration technique CPT 88108 • Pathology | $26 | $26 | $26 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $34 | $34 | $34 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $17 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $40 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $31 | $40 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $36 | $43 | $51 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $22 | $23 | $24 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $143 | $224 | $341 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $188 | $347 | $506 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $17 | $17 |
| Special stain group II CPT 88313 • Pathology | $8 | $54 | $100 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $36 | $36 | $36 |
| Frozen section pathology each additional CPT 88332 • Pathology | $6 | $6 | $6 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $44 | $80 | $115 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $23 | $79 | $135 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $70 | $70 | $70 |
| Microdissection manual CPT 88381 • Pathology | $124 | $124 | $124 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $8 | $8 | $8 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $17 | $18 | $19 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $15 | $15 | $15 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $17 | $18 | $18 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $15 | $17 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $29 | $33 | $37 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $42 | $44 | $47 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $36 | $37 | $37 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $27 | $30 | $34 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $18 | $18 | $18 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $101 | $108 | $115 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $81 | $99 | $117 |