| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,003 | $2,132 | $3,261 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $955 | $1,993 | $3,031 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,082 | $2,377 | $3,671 |
| Carpal tunnel release CPT 64721 • Orthopedics | $435 | $963 | $1,491 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $93 | $179 | $278 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $259 | $498 | $871 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $97 | $279 | $462 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $557 | $858 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $406 | $4,002 | $7,598 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $40 | $90 | $140 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $81 | $113 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $243 | $307 | $370 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $155 | $164 | $173 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $171 | $378 | $586 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $195 | $302 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $151 | $329 | $508 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $438 | $505 | $641 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $198 | $257 | $333 |
| Cytopathology concentration technique CPT 88108 • Pathology | $71 | $92 | $112 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $60 | $66 | $72 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $20 | $40 | $60 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $47 | $47 | $47 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $72 | $72 | $72 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $22 | $40 | $58 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $85 | $85 | $85 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $28 | $47 | $66 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $45 | $80 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $31 | $64 | $97 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $255 | $347 | $532 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $388 | $570 | $752 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $69 | $85 | $100 |
| Special stain group II CPT 88313 • Pathology | $31 | $51 | $71 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $60 | $82 | $105 |
| Frozen section pathology each additional CPT 88332 • Pathology | $49 | $96 | $143 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $79 | $114 | $149 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $90 | $129 | $168 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $103 | $106 | $109 |
| Microdissection manual CPT 88381 • Pathology | $454 | $454 | $454 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $10 | $12 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $27 | $27 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $26 | $29 | $32 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $32 | $32 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $22 | $27 | $32 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $40 | $53 | $65 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $48 | $75 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $48 | $57 | $65 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $51 | $56 | $60 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $30 | $35 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $223 | $223 | $223 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $56 | $139 | $223 |