| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,790 | $2,028 | $2,267 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,348 | $2,353 | $3,209 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,324 | $2,262 | $3,121 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $204 | $2,188 | $3,551 |
| Carpal tunnel release CPT 64721 • Orthopedics | $576 | $952 | $1,182 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $170 | $241 | $408 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $272 | $451 | $797 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $344 | $423 | $502 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $430 | $678 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $1,010 | $1,375 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $109 | $152 | $195 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $66 | $106 | $129 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $160 | $394 | $647 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $59 | $211 | $289 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $187 | $364 | $469 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $121 | $213 | $282 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $199 | $347 | $456 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $44 | $706 | $1,376 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $233 | $430 |
| Cytopathology concentration technique CPT 88108 • Pathology | $74 | $74 | $74 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $28 | $28 | $28 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $30 | $30 | $30 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $35 | $47 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $20 | $20 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $34 | $34 | $34 |
| 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 | $41 | $41 | $41 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $82 | $160 | $238 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $145 | $145 | $145 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $27 | $27 | $27 |
| Special stain group II CPT 88313 • Pathology | $50 | $50 | $50 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $34 | $34 | $34 |
| Frozen section pathology each additional CPT 88332 • Pathology | $12 | $12 | $12 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $21 | $53 | $71 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $30 | $30 | $30 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $54 | $54 | $54 |
| Microdissection manual CPT 88381 • Pathology | $175 | $205 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $12 | $16 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $29 | $35 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $29 | $30 | $31 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $33 | $43 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $18 | $27 | $35 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $37 | $58 | $75 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $48 | $67 | $80 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $37 | $57 | $72 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $34 | $56 | $67 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $38 | $38 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $117 | $190 | $243 |