| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $172 | $357 | $772 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,097 | $1,784 | $4,001 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $432 | $967 | $1,972 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $366 | $763 | $1,346 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $726 | $1,349 | $2,599 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $140 | $1,680 | $3,649 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $947 | $1,658 | $3,428 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $152 | $2,075 | $4,126 |
| Carpal tunnel release CPT 64721 • Orthopedics | $411 | $709 | $1,113 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $74 | $248 | $626 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $96 | $345 | $679 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $79 | $238 | $512 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $98 | $454 | $989 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $427 | $3,043 | $8,772 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $33 | $98 | $191 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $44 | $69 | $121 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $95 | $363 | $942 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $51 | $194 | $716 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $74 | $252 | $677 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $44 | $113 | $227 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $156 | $281 | $572 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $231 | $598 | $1,146 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $59 | $418 | $1,600 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $10 | $57 | $83 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $39 | $66 | $84 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $35 | $91 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $26 | $66 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $37 | $98 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $29 | $79 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $49 | $99 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $44 | $83 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $38 | $67 | $109 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $43 | $85 | $111 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $89 | $385 | $711 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $147 | $515 | $903 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $18 | $107 | $268 |
| Special stain group II CPT 88313 • Pathology | $5 | $84 | $214 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $123 | $345 |
| Frozen section pathology each additional CPT 88332 • Pathology | $23 | $49 | $97 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $114 | $334 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $30 | $100 | $206 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $103 | $246 |
| Microdissection manual CPT 88381 • Pathology | $25 | $241 | $578 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $11 | $24 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $19 | $47 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $19 | $44 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $22 | $54 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $21 | $53 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $39 | $73 |