| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $802 | $846 | $890 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $220 | $1,213 | $2,517 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $205 | $1,617 | $3,546 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,758 | $2,891 | $4,024 |
| Carpal tunnel release CPT 64721 • Orthopedics | $516 | $825 | $1,378 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $157 | $262 | $440 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $171 | $295 | $380 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $147 | $193 | $239 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $303 | $556 | $919 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $483 | $2,667 | $6,832 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $88 | $128 | $173 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $40 | $93 | $152 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $193 | $414 | $740 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $87 | $114 | $135 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $225 | $360 | $542 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $44 | $151 | $278 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $178 | $284 | $475 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $520 | $887 | $1,298 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $104 | $253 | $367 |
| Cytopathology concentration technique CPT 88108 • Pathology | $47 | $97 | $148 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $13 | $72 | $160 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $26 | $44 | $62 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $24 | $35 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $25 | $39 | $62 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $4 | $25 | $50 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $35 | $58 | $81 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $53 | $63 | $73 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $38 | $98 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $16 | $45 | $74 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $381 | $739 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $196 | $597 | $999 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $111 | $181 | $250 |
| Special stain group II CPT 88313 • Pathology | $5 | $35 | $71 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $68 | $86 | $104 |
| Frozen section pathology each additional CPT 88332 • Pathology | $29 | $80 | $130 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $110 | $220 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $107 | $250 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $64 | $84 | $105 |
| Microdissection manual CPT 88381 • Pathology | $134 | $281 | $427 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $9 | $17 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $16 | $23 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $17 | $22 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $17 | $26 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $18 | $29 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $37 | $62 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $30 | $34 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $38 | $61 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $35 | $57 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $18 | $28 | $37 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $114 | $173 |