| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $124 | $771 | $1,419 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $462 | $607 | $752 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $232 | $478 | $724 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $919 | $919 | $919 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $106 | $700 | $1,294 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $949 | $1,008 | $1,068 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,293 | $1,374 | $1,454 |
| Carpal tunnel release CPT 64721 • Orthopedics | $548 | $572 | $596 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $151 | $151 | $151 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $118 | $118 | $118 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $110 | $110 | $110 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $459 | $459 | $459 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $45 | $60 | $74 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $296 | $296 | $296 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $55 | $55 | $55 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $149 | $149 | $149 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $60 | $60 | $60 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $131 | $131 | $131 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $318 | $318 | $318 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $95 | $95 | $95 |
| Cytopathology concentration technique CPT 88108 • Pathology | $91 | $91 | $91 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $54 | $90 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $11 | $11 | $11 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $14 | $24 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $32 | $57 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $15 | $55 | $96 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $216 | $380 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $90 | $212 | $333 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $83 | $149 |
| Special stain group II CPT 88313 • Pathology | $8 | $58 | $109 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $59 | $79 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $18 | $69 | $120 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $81 | $140 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $93 | $160 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $17 | $17 | $17 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $15 | $19 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $19 | $19 | $19 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $40 | $40 | $40 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $46 | $46 | $46 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $40 | $40 | $40 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $37 | $37 | $37 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $24 | $24 | $24 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $136 | $136 | $136 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $136 | $136 | $136 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $105 | $120 | $136 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $94 | $94 | $94 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $49 | $49 | $49 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $44 | $44 | $44 |