| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $530 | $962 | $1,284 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $945 | $1,647 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $1,346 | $2,337 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $1,306 | $2,295 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,827 | $2,217 | $2,606 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $583 | $1,017 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $81 | $193 | $380 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $445 | $605 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $172 | $188 | $204 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $10 | $357 | $598 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $41 | $592 | $997 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $11 | $105 | $180 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $75 | $92 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $537 | $545 | $553 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $179 | $261 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $169 | $288 | $406 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $132 | $209 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $234 | $290 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $435 | $615 | $973 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $116 | $252 | $399 |
| Cytopathology concentration technique CPT 88108 • Pathology | $18 | $41 | $54 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $23 | $28 | $33 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $21 | $40 | $59 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $14 | $16 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $32 | $51 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $9 | $16 | $19 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $28 | $29 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $6 | $13 | $20 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $9 | $17 | $25 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $31 | $56 | $82 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $67 | $133 | $219 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $118 | $130 | $141 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $77 | $84 | $91 |
| Special stain group II CPT 88313 • Pathology | $31 | $50 | $63 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $29 | $34 | $40 |
| Frozen section pathology each additional CPT 88332 • Pathology | $20 | $34 | $48 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $23 | $83 | $159 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $29 | $87 | $183 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $34 | $65 | $93 |
| Microdissection manual CPT 88381 • Pathology | $19 | $75 | $131 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $7 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $11 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $10 | $13 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $13 | $16 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $12 | $16 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $26 | $33 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $30 | $38 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $26 | $33 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $24 | $30 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $16 | $20 |