| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $155 | $395 | $734 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $962 | $1,190 | $1,539 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $506 | $641 | $821 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $487 | $656 | $875 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $620 | $769 | $998 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $880 | $1,122 | $1,403 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $837 | $1,141 | $1,556 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $949 | $1,282 | $1,588 |
| Carpal tunnel release CPT 64721 • Orthopedics | $381 | $523 | $700 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $83 | $183 | $268 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $124 | $250 | $377 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $98 | $133 | $173 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $113 | $243 | $371 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $431 | $943 | $2,012 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $65 | $95 | $125 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $42 | $55 | $78 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $115 | $209 | $355 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $72 | $104 | $140 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $84 | $145 | $258 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $57 | $65 | $78 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $132 | $167 | $242 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $260 | $497 | $682 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $69 | $180 | $286 |
| Cytopathology concentration technique CPT 88108 • Pathology | $16 | $45 | $91 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $25 | $55 | $99 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $24 | $41 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $13 | $26 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $25 | $39 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $18 | $31 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $17 | $31 | $54 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $19 | $35 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $31 | $63 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $38 | $58 | $92 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $66 | $180 | $421 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $131 | $345 | $627 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $37 | $63 | $114 |
| Special stain group II CPT 88313 • Pathology | $42 | $76 | $146 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $36 | $62 | $86 |
| Frozen section pathology each additional CPT 88332 • Pathology | $6 | $39 | $80 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $27 | $64 | $92 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $24 | $42 | $79 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $38 | $66 | $94 |
| Microdissection manual CPT 88381 • Pathology | $32 | $124 | $302 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $12 | $18 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $13 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $15 | $21 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $13 | $21 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $30 | $43 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $31 | $48 |