| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $621 | $818 | $1,084 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $58 | $723 | $1,342 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $412 | $1,350 | $2,381 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $383 | $1,953 | $3,131 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $139 | $1,324 | $3,549 |
| Carpal tunnel release CPT 64721 • Orthopedics | $56 | $566 | $1,052 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $95 | $131 | $204 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $125 | $129 | $135 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $67 | $242 | $452 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $97 | $409 | $840 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $69 | $1,972 | $4,508 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $62 | $100 | $131 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $21 | $48 | $75 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $263 | $387 | $448 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $19 | $93 | $131 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $106 | $139 | $204 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $60 | $127 | $214 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $102 | $213 | $359 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $73 | $376 | $544 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $278 | $321 | $408 |
| Cytopathology concentration technique CPT 88108 • Pathology | $28 | $52 | $81 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $39 | $60 | $84 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $21 | $28 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $15 | $17 | $21 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $5 | $19 | $35 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $4 | $15 | $28 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $27 | $35 | $43 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $22 | $38 | $52 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $23 | $52 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $30 | $52 | $91 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $160 | $361 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $182 | $343 | $550 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $47 | $92 | $142 |
| Special stain group II CPT 88313 • Pathology | $34 | $68 | $102 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $38 | $47 | $51 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $37 | $69 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $54 | $79 | $112 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $68 | $128 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $64 | $84 | $99 |
| Microdissection manual CPT 88381 • Pathology | $49 | $160 | $263 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $33 | $77 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $17 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $18 | $28 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $22 | $35 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $16 | $49 | $77 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $21 | $47 | $77 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $52 | $77 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $21 | $45 | $71 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $40 | $65 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $21 | $58 | $77 |