| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $155 | $244 | $627 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $962 | $1,549 | $4,001 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $506 | $721 | $1,073 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $487 | $675 | $920 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $620 | $1,129 | $2,599 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $796 | $1,613 | $3,649 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $837 | $1,611 | $3,428 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $148 | $1,640 | $4,126 |
| Carpal tunnel release CPT 64721 • Orthopedics | $381 | $799 | $2,792 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $92 | $236 | $626 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $106 | $311 | $621 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $78 | $189 | $512 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $99 | $364 | $989 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $413 | $2,213 | $8,772 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $78 | $123 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $34 | $58 | $84 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $105 | $341 | $942 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $55 | $156 | $581 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $74 | $198 | $677 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $44 | $122 | $395 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $128 | $249 | $572 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $178 | $608 | $1,182 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $55 | $125 | $246 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $8 | $59 | $150 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $22 | $55 | $104 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $38 | $91 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $20 | $66 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $34 | $98 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $28 | $79 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $35 | $56 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $20 | $32 | $57 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $42 | $90 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $31 | $62 | $88 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $73 | $292 | $614 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $141 | $448 | $1,089 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $18 | $77 | $129 |
| Special stain group II CPT 88313 • Pathology | $18 | $59 | $95 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $16 | $69 | $114 |
| Frozen section pathology each additional CPT 88332 • Pathology | $8 | $49 | $97 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $71 | $114 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $31 | $81 | $129 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $54 | $101 | $140 |
| Microdissection manual CPT 88381 • Pathology | $23 | $134 | $246 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $9 | $24 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $18 | $47 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $19 | $44 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $20 | $54 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $18 | $53 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $30 | $50 |