| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $992 | $1,338 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $944 | $1,094 | $1,314 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,124 | $1,396 | $1,492 |
| Carpal tunnel release CPT 64721 • Orthopedics | $433 | $545 | $596 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $110 | $164 | $218 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $113 | $230 | $347 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $117 | $117 | $117 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $105 | $224 | $342 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,528 | $2,528 | $2,528 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $21 | $69 | $103 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $54 | $66 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $109 | $213 | $317 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $49 | $60 | $72 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $143 | $188 | $233 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $72 | $76 | $81 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $139 | $170 | $202 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $304 | $304 | $305 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $83 | $88 | $94 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $75 | $91 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $16 | $62 | $90 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $14 | $15 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $15 | $16 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $23 | $30 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $9 | $21 | $44 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $17 | $42 | $57 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $19 | $55 | $96 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $280 | $380 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $153 | $372 | $573 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $44 | $110 | $149 |
| Special stain group II CPT 88313 • Pathology | $9 | $69 | $109 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $69 | $135 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $49 | $73 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $17 | $80 | $120 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $27 | $88 | $140 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $87 | $160 |
| Microdissection manual CPT 88381 • Pathology | $103 | $103 | $103 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $6 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $14 | $17 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $11 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $17 | $19 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $17 | $19 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $21 | $34 | $40 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $27 | $39 | $46 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $32 | $40 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $6 | $28 | $37 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $21 | $24 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $115 | $136 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $73 | $107 | $136 |