| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $38 | $297 | $557 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $850 | $850 | $850 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $949 | $1,161 | $1,522 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,196 | $1,460 | $1,725 |
| Carpal tunnel release CPT 64721 • Orthopedics | $376 | $500 | $690 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $110 | $152 | $205 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $169 | $220 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $121 | $121 | $121 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $85 | $243 | $413 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $38 | $1,142 | $2,288 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $52 | $82 | $121 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $29 | $50 | $67 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $96 | $277 | $386 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $84 | $115 | $155 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $140 | $195 | $277 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $72 | $108 | $143 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $107 | $165 | $238 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $193 | $502 | $656 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $72 | $205 | $271 |
| Cytopathology concentration technique CPT 88108 • Pathology | $22 | $33 | $44 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $22 | $38 | $61 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $10 | $12 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $9 | $13 | $19 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $23 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $24 | $30 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $18 | $34 | $63 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $23 | $35 | $50 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $112 | $156 | $226 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $92 | $142 | $193 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $39 | $49 | $61 |
| Special stain group II CPT 88313 • Pathology | $32 | $41 | $46 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $49 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $31 | $58 | $84 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $18 | $30 | $41 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $21 | $53 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $34 | $42 |
| Microdissection manual CPT 88381 • Pathology | $16 | $74 | $133 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $14 | $21 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $10 | $13 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $14 | $15 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $10 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $23 | $25 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $14 | $22 | $29 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $29 | $47 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $20 | $23 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $12 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $57 | $64 | $75 |