| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $966 | $1,934 | $2,902 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $948 | $1,921 | $2,895 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,081 | $2,184 | $3,287 |
| Carpal tunnel release CPT 64721 • Orthopedics | $416 | $838 | $1,260 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $156 | $308 | $460 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $239 | $276 | $314 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $87 | $170 | $254 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $100 | $403 | $706 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,275 | $2,544 | $3,813 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $45 | $89 | $132 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $35 | $87 | $138 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $212 | $421 | $630 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $52 | $102 | $152 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $167 | $331 | $496 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $84 | $167 | $249 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $121 | $190 | $260 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $223 | $710 | $1,197 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $167 | $330 | $494 |
| Cytopathology concentration technique CPT 88108 • Pathology | $41 | $57 | $73 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $47 | $78 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $19 | $22 | $25 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $13 | $17 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $26 | $31 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $18 | $25 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $19 | $29 | $39 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $28 | $37 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $28 | $48 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $19 | $49 | $79 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $125 | $229 | $333 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $90 | $299 | $507 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $56 | $93 | $130 |
| Special stain group II CPT 88313 • Pathology | $7 | $51 | $94 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $20 | $29 | $38 |
| Frozen section pathology each additional CPT 88332 • Pathology | $29 | $46 | $63 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $35 | $71 | $108 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $37 | $38 | $39 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $49 | $59 | $69 |
| Microdissection manual CPT 88381 • Pathology | $51 | $143 | $235 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $15 | $21 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $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 | $24 | $36 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $31 | $43 | $55 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $33 | $63 | $93 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $28 | $54 | $81 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $29 | $52 | $74 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $17 | $17 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $78 | $151 | $224 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $78 | $151 | $224 |