| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $956 | $1,215 | $1,594 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,088 | $1,344 | $1,472 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,238 | $1,468 | $1,698 |
| Carpal tunnel release CPT 64721 • Orthopedics | $467 | $595 | $659 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $93 | $196 | $335 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $123 | $207 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $98 | $98 | $98 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $256 | $260 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,388 | $1,388 | $1,388 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $86 | $121 | $163 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $50 | $52 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $232 | $394 | $556 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $51 | $137 | $267 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $171 | $177 | $183 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $90 | $93 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $153 | $160 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $437 | $439 | $443 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $67 | $175 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $22 | $37 | $52 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $34 | $52 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $19 | $30 | $40 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $12 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $50 | $66 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $18 | $18 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $19 | $23 | $26 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $13 | $19 | $25 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $20 | $33 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $16 | $22 | $29 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $152 | $185 | $218 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $142 | $235 | $328 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $39 | $62 | $85 |
| Special stain group II CPT 88313 • Pathology | $32 | $47 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $57 | $67 | $78 |
| Frozen section pathology each additional CPT 88332 • Pathology | $11 | $27 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $52 | $60 | $69 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $61 | $71 | $80 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $60 | $70 | $80 |
| Microdissection manual CPT 88381 • Pathology | $53 | $102 | $151 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $13 | $13 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $16 | $16 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $16 | $16 | $16 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $36 | $46 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $38 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $23 | $24 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $23 | $24 | $25 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $68 | $76 | $85 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $68 | $76 | $84 |