| Discectomy lumbar single level CPT 63030 • Orthopedics | $7,944 | $9,051 | $13,479 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $7,944 | $9,328 | $13,479 |
| Carpal tunnel release CPT 64721 • Orthopedics | $6,575 | $6,878 | $6,954 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $1,085 | $5,780 | $6,954 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $1,755 | $5,914 | $6,954 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $1,755 | $5,654 | $6,953 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $1,755 | $5,914 | $6,954 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $6,953 | $8,258 | $13,479 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $1,755 | $5,914 | $6,954 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $1,085 | $5,780 | $6,954 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $1,755 | $5,654 | $6,953 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $1,085 | $5,123 | $6,954 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $1,755 | $5,654 | $6,953 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $1,085 | $5,780 | $6,954 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $1,085 | $5,780 | $6,954 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $6,575 | $6,878 | $6,954 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $1,085 | $5,780 | $6,954 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $1,085 | $4,665 | $6,953 |
| Cytopathology concentration technique CPT 88108 • Pathology | $15 | $73 | $87 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $15 | $64 | $81 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $39 | $47 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $30 | $35 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $51 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $44 | $62 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $16 | $57 | $71 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $7 | $40 | $51 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $15 | $51 | $63 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $15 | $56 | $70 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $21 | $343 | $423 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $21 | $458 | $604 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $7 | $136 | $179 |
| Special stain group II CPT 88313 • Pathology | $7 | $116 | $143 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $15 | $70 | $84 |
| Frozen section pathology each additional CPT 88332 • Pathology | $7 | $39 | $50 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $27 | $106 | $125 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $21 | $114 | $138 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $21 | $136 | $165 |
| Microdissection manual CPT 88381 • Pathology | $386 | $386 | $386 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $14 | $14 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $29 | $29 | $29 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $27 | $27 | $27 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $34 | $34 | $34 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $33 | $33 | $33 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $68 | $68 | $68 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $78 | $78 | $78 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $68 | $68 | $68 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $62 | $62 | $62 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $41 | $41 | $41 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $230 | $230 | $230 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $230 | $230 | $230 |