| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $574 | $1,117 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $806 | $1,582 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $784 | $1,539 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,751 | $1,751 | $1,751 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $354 | $678 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $144 | $258 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $179 | $219 | $258 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $248 | $248 | $248 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $320 | $386 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $354 | $678 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $8 | $67 | $127 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $63 | $77 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $352 | $352 | $352 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $85 | $141 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $150 | $150 | $150 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $114 | $139 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $175 | $200 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $437 | $558 | $678 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $99 | $170 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $22 | $36 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $32 | $32 | $32 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $30 | $30 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $28 | $35 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $9 | $14 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $67 | $67 | $67 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $190 | $204 | $219 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $269 | $269 | $269 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $89 | $89 | $89 |
| Special stain group II CPT 88313 • Pathology | $62 | $62 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $34 | $37 | $40 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $42 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $43 | $55 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $54 | $65 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $93 | $108 | $123 |
| Microdissection manual CPT 88381 • Pathology | $152 | $152 | $152 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $13 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $14 | $18 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $15 | $19 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $12 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $31 | $31 | $31 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $32 | $32 | $32 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $26 | $28 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $29 | $29 | $29 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $17 | $17 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $78 | $78 | $78 |