| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $196 | $425 | $659 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,075 | $14,342 | $39,985 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $552 | $8,542 | $24,371 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $532 | $8,975 | $24,371 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $667 | $8,865 | $24,371 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $211 | $14,576 | $39,985 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $894 | $15,044 | $39,985 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,032 | $14,288 | $39,985 |
| Carpal tunnel release CPT 64721 • Orthopedics | $403 | $5,923 | $15,559 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $190 | $454 | $1,019 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $129 | $2,193 | $6,154 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $103 | $2,158 | $6,154 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $118 | $2,226 | $6,154 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $401 | $13,766 | $39,985 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $64 | $2,112 | $6,154 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $32 | $205 | $509 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $105 | $2,172 | $6,154 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $49 | $258 | $509 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $84 | $2,166 | $6,154 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $87 | $256 | $509 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $142 | $299 | $509 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $260 | $5,610 | $15,559 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $69 | $441 | $1,198 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $502 | $506 | $509 |
| Cytopathology concentration technique CPT 88108 • Pathology | $20 | $79 | $150 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $19 | $73 | $118 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $12 | $23 | $40 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $11 | $16 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $29 | $41 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $34 | $62 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $28 | $48 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $7 | $27 | $41 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $28 | $55 | $83 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $40 | $70 | $107 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $181 | $275 | $379 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $142 | $289 | $575 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $29 | $64 | $131 |
| Special stain group II CPT 88313 • Pathology | $24 | $70 | $105 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $40 | $76 | $127 |
| Frozen section pathology each additional CPT 88332 • Pathology | $22 | $47 | $80 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $19 | $37 | $77 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $45 | $91 | $113 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $20 | $86 | $168 |
| Microdissection manual CPT 88381 • Pathology | $44 | $135 | $206 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $0 | $5 | $8 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $14 | $20 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $15 | $19 | $24 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $15 | $18 | $24 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $11 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $26 | $29 | $33 |