| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $547 | $3,950 | $14,599 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $704 | $4,346 | $14,599 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $191 | $6,539 | $22,799 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $643 | $5,974 | $22,799 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $730 | $6,720 | $22,799 |
| Carpal tunnel release CPT 64721 • Orthopedics | $516 | $3,168 | $10,754 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $72 | $321 | $917 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $106 | $778 | $2,788 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $78 | $797 | $2,788 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $118 | $886 | $2,788 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $550 | $6,934 | $22,799 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $48 | $760 | $2,788 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $34 | $247 | $917 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $110 | $921 | $2,788 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $50 | $287 | $917 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $90 | $839 | $2,788 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $50 | $279 | $917 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $136 | $399 | $917 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $260 | $3,053 | $10,754 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $69 | $358 | $917 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $896 | $907 | $917 |
| Cytopathology concentration technique CPT 88108 • Pathology | $6 | $36 | $57 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $20 | $56 | $113 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $27 | $57 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $17 | $33 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $14 | $27 | $46 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $8 | $30 | $62 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $18 | $37 | $75 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $24 | $34 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $3 | $28 | $44 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $11 | $38 | $65 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $46 | $181 | $260 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $39 | $246 | $396 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $7 | $69 | $103 |
| Special stain group II CPT 88313 • Pathology | $7 | $53 | $76 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $34 | $68 | $94 |
| Frozen section pathology each additional CPT 88332 • Pathology | $12 | $33 | $50 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $16 | $78 | $205 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $35 | $72 | $92 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $34 | $86 | $130 |
| Microdissection manual CPT 88381 • Pathology | $14 | $60 | $135 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $7 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $19 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $19 | $27 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $17 | $27 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $14 | $18 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $32 | $45 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $27 | $40 | $67 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $23 | $30 | $40 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $25 | $29 | $42 |