| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $589 | $674 | $771 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $834 | $962 | $1,177 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $811 | $916 | $1,025 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $923 | $1,072 | $1,220 |
| Carpal tunnel release CPT 64721 • Orthopedics | $355 | $464 | $520 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $77 | $173 | $260 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $207 | $290 | $313 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $131 | $162 | $197 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $130 | $237 | $307 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $391 | $1,175 | $2,732 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $39 | $85 | $118 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $49 | $54 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $130 | $227 | $297 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $45 | $115 | $209 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $115 | $171 | $212 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $73 | $97 | $106 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $118 | $152 | $165 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $194 | $413 | $521 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $82 | $217 | $285 |
| Cytopathology concentration technique CPT 88108 • Pathology | $13 | $15 | $17 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $37 | $57 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $15 | $18 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $8 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $5 | $13 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $13 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $13 | $16 | $18 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $8 | $13 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $6 | $26 | $46 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $18 | $41 | $78 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $87 | $125 | $163 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $61 | $74 | $87 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $15 | $79 | $125 |
| Special stain group II CPT 88313 • Pathology | $6 | $57 | $93 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $32 | $55 | $107 |
| Frozen section pathology each additional CPT 88332 • Pathology | $16 | $20 | $25 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $62 | $107 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $18 | $73 | $125 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $22 | $82 | $136 |
| Microdissection manual CPT 88381 • Pathology | $26 | $29 | $32 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $12 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $13 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $15 | $17 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $13 | $16 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $23 | $29 | $32 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $31 | $36 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $23 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $27 | $30 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $15 | $15 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $70 | $70 | $70 |