| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,272 | $2,267 | $3,261 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,165 | $2,098 | $3,031 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,347 | $2,509 | $3,671 |
| Carpal tunnel release CPT 64721 • Orthopedics | $528 | $1,010 | $1,491 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $90 | $301 | $542 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $125 | $262 | $357 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $270 | $270 | $270 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $299 | $315 | $331 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,637 | $5,117 | $7,598 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $131 | $190 | $250 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $167 | $167 | $167 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $448 | $633 | $817 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $61 | $216 | $372 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $204 | $395 | $586 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $105 | $138 | $172 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $178 | $291 | $404 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $511 | $554 | $641 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $198 | $251 | $278 |
| Cytopathology concentration technique CPT 88108 • Pathology | $112 | $112 | $112 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $101 | $101 | $101 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $60 | $60 | $60 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $47 | $47 | $47 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $72 | $72 | $72 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $58 | $58 | $58 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $85 | $85 | $85 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $66 | $66 | $66 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $97 | $97 | $97 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $214 | $214 | $214 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $752 | $752 | $752 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $289 | $289 | $289 |
| Special stain group II CPT 88313 • Pathology | $209 | $209 | $209 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $161 | $161 | $161 |
| Frozen section pathology each additional CPT 88332 • Pathology | $143 | $143 | $143 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $223 | $223 | $223 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $168 | $168 | $168 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $305 | $305 | $305 |
| Microdissection manual CPT 88381 • Pathology | $62 | $62 | $62 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $14 | $14 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $23 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $26 | $26 | $26 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $32 | $32 | $32 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $32 | $32 | $32 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $37 | $51 | $65 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $39 | $57 | $75 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $33 | $49 | $65 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $36 | $48 | $60 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $39 | $39 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $71 | $147 | $223 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $71 | $147 | $223 |