| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,223 | $2,242 | $3,261 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,496 | $2,152 | $2,808 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $305 | $1,988 | $3,671 |
| Carpal tunnel release CPT 64721 • Orthopedics | $717 | $1,104 | $1,491 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $157 | $350 | $542 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $456 | $663 | $871 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $443 | $443 | $443 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $450 | $455 | $460 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $519 | $4,058 | $7,598 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $136 | $206 | $277 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $167 | $167 | $167 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $329 | $559 | $790 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $76 | $180 | $284 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $178 | $235 | $292 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $148 | $160 | $172 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $247 | $378 | $508 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $418 | $943 | $1,468 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $113 | $457 | $800 |
| Cytopathology concentration technique CPT 88108 • Pathology | $23 | $41 | $72 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $34 | $62 | $103 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $28 | $42 | $60 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $16 | $32 | $47 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $17 | $18 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $19 | $19 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $30 | $59 | $94 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $28 | $50 | $73 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $15 | $35 | $61 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $49 | $113 | $185 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $183 | $202 | $214 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $190 | $419 | $752 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $34 | $67 | $98 |
| Special stain group II CPT 88313 • Pathology | $21 | $101 | $209 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $91 | $100 | $110 |
| Frozen section pathology each additional CPT 88332 • Pathology | $41 | $58 | $80 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $36 | $74 | $112 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $36 | $60 | $99 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $55 | $141 | $305 |
| Microdissection manual CPT 88381 • Pathology | $45 | $237 | $454 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $14 | $14 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $18 | $21 | $24 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $18 | $23 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $31 | $32 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $15 | $24 | $32 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $50 | $58 | $65 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $44 | $59 | $75 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $34 | $50 | $65 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $28 | $29 | $30 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $32 | $32 | $32 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $106 | $164 | $223 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $170 | $197 | $223 |