| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $20 | $204 | $366 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $720 | $1,302 | $2,285 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $432 | $757 | $1,208 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $476 | $754 | $1,164 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $671 | $914 | $1,476 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $657 | $1,148 | $2,089 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $904 | $1,201 | $2,460 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $130 | $1,244 | $2,784 |
| Carpal tunnel release CPT 64721 • Orthopedics | $308 | $587 | $1,119 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $77 | $167 | $351 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $71 | $248 | $672 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $75 | $152 | $352 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $66 | $229 | $663 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $413 | $1,625 | $6,042 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $37 | $86 | $191 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $34 | $66 | $123 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $75 | $262 | $631 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $21 | $115 | $285 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $74 | $168 | $442 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $44 | $108 | $228 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $100 | $181 | $390 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $178 | $587 | $1,134 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $56 | $185 | $631 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $5 | $51 | $98 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $18 | $56 | $94 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $30 | $47 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $4 | $15 | $31 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $35 | $81 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $27 | $46 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $39 | $62 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $33 | $64 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $16 | $41 | $82 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $29 | $68 | $98 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $66 | $288 | $549 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $112 | $398 | $817 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $24 | $85 | $154 |
| Special stain group II CPT 88313 • Pathology | $5 | $80 | $124 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $30 | $66 | $137 |
| Frozen section pathology each additional CPT 88332 • Pathology | $8 | $49 | $82 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $11 | $65 | $120 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $35 | $94 | $138 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $20 | $84 | $164 |
| Microdissection manual CPT 88381 • Pathology | $113 | $232 | $377 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $7 | $16 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $12 | $19 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $12 | $18 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $14 | $21 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $13 | $20 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $32 | $54 |