| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,452 | $1,668 | $2,099 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $609 | $609 | $609 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $2,320 | $2,320 | $2,320 |
| Carpal tunnel release CPT 64721 • Orthopedics | $272 | $421 | $496 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $52 | $232 | $332 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $497 | $524 | $551 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $292 | $292 | $292 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $158 | $158 | $158 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,173 | $1,173 | $1,173 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $27 | $98 | $133 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $106 | $106 | $106 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $516 | $516 | $516 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $32 | $32 | $32 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $107 | $296 | $485 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $55 | $152 | $249 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $94 | $94 | $94 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $799 | $863 | $928 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $105 | $217 | $328 |
| Cytopathology concentration technique CPT 88108 • Pathology | $24 | $24 | $24 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $24 | $24 | $24 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $10 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $16 | $16 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $19 | $19 | $19 |
| 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 | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $31 | $37 | $43 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $169 | $169 | $169 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $92 | $92 | $92 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $64 | $64 | $64 |
| Special stain group II CPT 88313 • Pathology | $8 | $8 | $8 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $21 | $21 | $21 |
| Frozen section pathology each additional CPT 88332 • Pathology | $14 | $14 | $14 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $39 | $39 | $39 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $57 | $57 | $57 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $50 | $50 | $50 |
| Microdissection manual CPT 88381 • Pathology | $94 | $94 | $94 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $13 | $13 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $9 | $9 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $25 | $30 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $22 | $22 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $24 | $27 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $24 | $24 | $24 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $16 | $16 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $88 | $91 | $94 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $53 | $53 | $53 |