| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $689 | $1,348 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,898 | $1,898 | $1,898 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $895 | $1,382 | $1,870 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,014 | $1,573 | $2,131 |
| Carpal tunnel release CPT 64721 • Orthopedics | $820 | $820 | $820 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $151 | $228 | $304 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $469 | $469 | $469 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $296 | $296 | $296 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $239 | $350 | $460 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $806 | $806 | $806 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $89 | $89 | $89 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $45 | $56 | $68 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $415 | $415 | $415 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $166 | $166 | $166 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $160 | $243 | $327 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $83 | $124 | $166 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $141 | $191 | $240 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $410 | $535 | $784 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $226 | $258 | $322 |
| Cytopathology concentration technique CPT 88108 • Pathology | $50 | $65 | $80 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $52 | $57 | $62 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $24 | $31 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $13 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $28 | $35 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $20 | $20 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $26 | $28 | $31 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $23 | $24 | $24 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $32 | $38 | $43 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $32 | $44 | $56 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $45 | $186 | $290 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $340 | $390 | $441 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $88 | $90 | $92 |
| Special stain group II CPT 88313 • Pathology | $12 | $38 | $63 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $36 | $36 | $36 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $43 | $44 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $43 | $56 | $69 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $50 | $65 | $79 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $33 | $44 | $55 |
| Microdissection manual CPT 88381 • Pathology | $117 | $140 | $163 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $6 | $11 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $19 | $29 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $22 | $35 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $22 | $35 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $16 | $24 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $40 | $60 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $42 | $62 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $36 | $53 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $37 | $55 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $22 | $32 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $68 | $109 | $149 |