| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $1,407 | $5,054 | $8,700 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $744 | $4,722 | $8,700 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,880 | $5,290 | $8,700 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $1,676 | $5,188 | $8,700 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $2,733 | $7,116 | $11,500 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,699 | $6,099 | $10,500 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $1,583 | $6,042 | $10,500 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,710 | $5,205 | $8,700 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $2,469 | $5,584 | $8,700 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $2,328 | $6,914 | $11,500 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,354 | $5,174 | $11,500 |
| Carpal tunnel release CPT 64721 • Orthopedics | $1,028 | $4,864 | $8,700 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $489 | $4,594 | $8,700 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $330 | $4,515 | $8,700 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $456 | $4,578 | $8,700 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $301 | $4,501 | $8,700 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,077 | $4,889 | $8,700 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $180 | $4,440 | $8,700 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $141 | $4,421 | $8,700 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $271 | $4,485 | $8,700 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $382 | $4,541 | $8,700 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $265 | $4,483 | $8,700 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $240 | $4,470 | $8,700 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $134 | $3,086 | $8,700 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $1,344 | $5,022 | $8,700 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $189 | $4,445 | $8,700 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $8,700 | $8,700 | $8,700 |
| Cytopathology concentration technique CPT 88108 • Pathology | $22 | $22 | $22 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $12 | $21 | $30 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $12 | $13 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $12 | $17 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $17 | $17 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $14 | $14 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $3 | $3 | $3 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $5 | $5 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $17 | $18 | $19 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $36 | $70 | $104 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $70 | $70 | $70 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $47 | $49 | $52 |
| Special stain group II CPT 88313 • Pathology | $5 | $6 | $6 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $31 | $31 |
| Frozen section pathology each additional CPT 88332 • Pathology | $5 | $5 | $5 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $19 | $25 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $33 | $50 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $19 | $24 | $28 |
| Microdissection manual CPT 88381 • Pathology | $81 | $81 | $81 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $11 | $12 | $12 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $13 | $13 | $13 |