| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $657 | $1,094 | $1,650 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $933 | $1,544 | $2,324 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $192 | $1,260 | $2,280 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,032 | $1,662 | $2,594 |
| Carpal tunnel release CPT 64721 • Orthopedics | $399 | $732 | $1,003 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $146 | $257 | $423 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $103 | $353 | $576 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $142 | $151 | $159 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $125 | $331 | $566 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $409 | $1,542 | $3,031 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $44 | $70 | $100 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $46 | $72 | $113 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $228 | $429 | $640 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $95 | $151 | $262 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $89 | $269 | $398 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $85 | $142 | $201 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $133 | $217 | $335 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $418 | $691 | $963 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $113 | $270 | $395 |
| Cytopathology concentration technique CPT 88108 • Pathology | $29 | $80 | $145 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $46 | $88 | $158 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $44 | $76 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $11 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $24 | $25 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $10 | $14 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $17 | $29 | $41 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $28 | $43 | $71 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $15 | $48 | $94 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $36 | $37 | $39 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $86 | $384 | $614 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $120 | $418 | $944 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $15 | $110 | $227 |
| Special stain group II CPT 88313 • Pathology | $7 | $57 | $160 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $53 | $87 | $155 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $60 | $123 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $12 | $103 | $210 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $43 | $99 | $247 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $68 | $183 | $325 |
| Microdissection manual CPT 88381 • Pathology | $61 | $144 | $226 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $8 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $18 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $22 | $33 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $25 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $19 | $30 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $29 | $48 | $76 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $31 | $40 | $47 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $26 | $37 | $49 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $27 | $43 | $71 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $17 | $19 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $74 | $123 | $191 |