| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $811 | $1,355 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $30 | $812 | $1,898 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $30 | $992 | $1,870 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $650 | $1,298 | $2,131 |
| Carpal tunnel release CPT 64721 • Orthopedics | $30 | $546 | $814 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $180 | $475 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $470 | $670 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $171 | $439 | $670 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $196 | $414 | $670 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $779 | $1,759 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $281 | $475 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $352 | $670 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $415 | $455 | $475 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $282 | $475 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $327 | $487 | $670 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $362 | $670 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $402 | $670 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $475 | $576 | $784 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $118 | $396 | $670 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $475 | $540 | $670 |
| Cytopathology concentration technique CPT 88108 • Pathology | $23 | $43 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $51 | $55 | $62 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $22 | $31 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $13 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $25 | $35 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $18 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $28 | $31 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $11 | $23 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $22 | $29 | $43 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $29 | $32 | $38 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $84 | $185 | $219 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $148 | $271 | $333 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $27 | $52 | $65 |
| Special stain group II CPT 88313 • Pathology | $12 | $44 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $48 | $60 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $23 | $26 | $31 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $45 | $55 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $77 | $79 | $86 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $55 | $67 | $93 |
| Microdissection manual CPT 88381 • Pathology | $92 | $124 | $140 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $8 | $11 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $19 | $29 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $22 | $35 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $23 | $35 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $20 | $24 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $55 | $57 | $60 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $57 | $58 | $62 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $37 | $53 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $51 | $52 | $55 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $30 | $31 | $32 |