| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $28 | $444 | $863 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $570 | $1,259 | $1,494 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $514 | $766 | $888 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $338 | $696 | $829 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $438 | $824 | $967 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,287 | $1,342 | $1,475 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $110 | $1,026 | $1,358 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $695 | $1,300 | $1,538 |
| Carpal tunnel release CPT 64721 • Orthopedics | $508 | $559 | $619 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $96 | $217 | $397 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $137 | $373 | $646 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $110 | $226 | $379 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $125 | $325 | $636 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $355 | $2,336 | $5,720 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $29 | $120 | $194 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $27 | $65 | $122 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $114 | $313 | $607 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $80 | $174 | $276 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $63 | $218 | $427 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $54 | $118 | $222 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $186 | $236 | $374 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $227 | $580 | $1,092 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $61 | $291 | $601 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $11 | $36 | $56 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $22 | $45 | $90 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $9 | $18 | $34 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $14 | $23 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $24 | $37 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $16 | $29 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $9 | $21 | $46 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $8 | $33 | $71 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $18 | $57 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $29 | $40 | $52 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $44 | $166 | $380 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $33 | $180 | $403 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $11 | $53 | $118 |
| Special stain group II CPT 88313 • Pathology | $3 | $31 | $95 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $48 | $66 |
| Frozen section pathology each additional CPT 88332 • Pathology | $6 | $22 | $33 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $25 | $42 | $89 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $25 | $47 | $97 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $57 | $113 |
| Microdissection manual CPT 88381 • Pathology | $43 | $123 | $246 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $7 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $14 | $19 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $15 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $16 | $21 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $15 | $20 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $29 | $34 | $42 |