| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $102 | $1,363 | $2,638 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $180 | $1,417 | $2,655 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,360 | $2,196 | $3,031 |
| Carpal tunnel release CPT 64721 • Orthopedics | $102 | $604 | $1,125 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $102 | $212 | $352 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $250 | $285 | $311 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $234 | $234 | $234 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $267 | $368 | $530 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $102 | $572 | $1,095 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $56 | $135 | $204 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $66 | $95 | $124 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $418 | $502 | $561 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $137 | $169 | $226 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $187 | $324 | $443 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $121 | $174 | $223 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $181 | $263 | $343 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $250 | $809 | $1,070 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $68 | $190 | $400 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $32 | $53 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $50 | $86 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $26 | $39 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $10 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $35 | $58 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $14 | $16 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $19 | $27 | $41 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $16 | $36 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $29 | $46 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $44 | $47 | $49 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $52 | $140 | $221 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $190 | $228 | $276 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $34 | $53 | $66 |
| Special stain group II CPT 88313 • Pathology | $16 | $34 | $48 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $20 | $53 | $81 |
| Frozen section pathology each additional CPT 88332 • Pathology | $30 | $34 | $40 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $17 | $27 | $37 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $46 | $70 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $38 | $46 | $55 |
| Microdissection manual CPT 88381 • Pathology | $69 | $69 | $69 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $15 | $15 | $15 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $18 | $29 | $40 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $31 | $48 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $33 | $49 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $25 | $33 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $38 | $60 | $82 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $47 | $67 | $86 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $34 | $53 | $72 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $31 | $54 | $76 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $44 | $44 | $44 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $106 | $157 | $208 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $106 | $157 | $208 |