| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $704 | $1,244 | $1,822 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $653 | $1,193 | $1,752 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $704 | $1,490 | $2,267 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $160 | $1,902 | $3,209 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $152 | $1,878 | $3,121 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,441 | $2,416 | $3,551 |
| Carpal tunnel release CPT 64721 • Orthopedics | $530 | $940 | $1,376 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $83 | $318 | $523 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $108 | $441 | $797 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $86 | $336 | $502 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $148 | $511 | $782 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $550 | $2,589 | $5,692 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $63 | $125 | $189 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $50 | $90 | $157 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $95 | $324 | $626 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $44 | $170 | $285 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $115 | $358 | $561 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $65 | $183 | $282 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $178 | $306 | $456 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $216 | $780 | $1,376 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $87 | $395 | $604 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $0 | $0 |
| Cytopathology concentration technique CPT 88108 • Pathology | $16 | $50 | $74 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $22 | $64 | $127 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $33 | $64 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $20 | $47 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $39 | $68 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $29 | $55 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $40 | $87 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $7 | $32 | $86 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $20 | $44 | $83 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $16 | $63 | $93 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $94 | $284 | $743 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $131 | $322 | $754 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $11 | $51 | $125 |
| Special stain group II CPT 88313 • Pathology | $8 | $33 | $89 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $90 | $258 |
| Frozen section pathology each additional CPT 88332 • Pathology | $8 | $34 | $75 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $67 | $98 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $56 | $113 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $51 | $114 | $308 |
| Microdissection manual CPT 88381 • Pathology | $52 | $147 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $10 | $17 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $26 | $35 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $27 | $42 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $30 | $43 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $23 | $37 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $53 | $76 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $56 | $84 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $49 | $76 |