| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $433 | $745 | $1,088 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $808 | $1,136 | $1,532 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,129 | $1,288 | $1,504 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,032 | $1,415 | $1,710 |
| Carpal tunnel release CPT 64721 • Orthopedics | $399 | $538 | $662 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $170 | $297 | $523 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $171 | $241 | $311 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $231 | $235 | $239 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $144 | $282 | $373 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $483 | $1,539 | $4,242 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $36 | $74 | $133 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $57 | $75 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $140 | $234 | $334 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $51 | $108 | $135 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $171 | $222 | $262 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $106 | $157 | $282 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $178 | $271 | $456 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $250 | $695 | $1,376 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $178 | $286 |
| Cytopathology concentration technique CPT 88108 • Pathology | $19 | $33 | $53 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $50 | $86 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $25 | $39 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $10 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $31 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $10 | $13 | $16 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $17 | $26 | $41 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $22 | $29 | $36 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $15 | $30 | $46 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $30 | $43 | $49 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $76 | $148 | $221 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $145 | $185 | $220 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $62 | $72 | $88 |
| Special stain group II CPT 88313 • Pathology | $12 | $25 | $48 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $17 | $39 | $81 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $30 | $40 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $34 | $62 | $76 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $46 | $70 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $55 | $70 | $86 |
| Microdissection manual CPT 88381 • Pathology | $152 | $194 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $10 | $11 | $13 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $27 | $35 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $30 | $42 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $17 | $27 | $38 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $21 | $27 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $36 | $61 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $44 | $58 | $74 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $37 | $51 | $63 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $27 | $42 | $67 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $19 | $28 | $38 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $74 | $90 | $106 |