| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $671 | $1,085 | $1,499 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,346 | $1,737 | $2,129 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,169 | $1,732 | $2,295 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $785 | $1,694 | $2,604 |
| Carpal tunnel release CPT 64721 • Orthopedics | $289 | $666 | $1,044 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $38 | $162 | $342 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $234 | $296 | $357 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $184 | $212 | $240 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $537 | $572 | $607 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,056 | $1,136 | $1,217 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $161 | $189 | $217 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $38 | $79 | $119 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $498 | $539 | $580 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $58 | $76 | $94 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $366 | $388 | $410 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $113 | $164 | $214 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $254 | $307 | $360 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $876 | $967 | $1,043 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $359 | $524 | $693 |
| Cytopathology concentration technique CPT 88108 • Pathology | $35 | $76 | $116 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $121 | $143 | $165 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $31 | $36 | $41 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $21 | $27 | $32 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $35 | $54 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $43 | $43 | $43 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $37 | $50 | $62 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $10 | $33 | $56 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $63 | $69 | $74 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $35 | $58 | $80 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $174 | $395 | $513 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $351 | $568 | $784 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $71 | $136 | $201 |
| Special stain group II CPT 88313 • Pathology | $12 | $78 | $143 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $94 | $94 | $94 |
| Frozen section pathology each additional CPT 88332 • Pathology | $52 | $76 | $100 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $86 | $123 | $159 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $98 | $140 | $182 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $80 | $99 | $117 |
| Microdissection manual CPT 88381 • Pathology | $75 | $222 | $370 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $7 | $9 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $12 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $12 | $14 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $14 | $16 | $18 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $18 | $20 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $39 | $40 | $41 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $36 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $34 | $36 | $37 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $27 | $31 | $34 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $20 | $25 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $72 | $107 | $142 |