| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $648 | $2,974 | $7,944 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $344 | $1,912 | $6,953 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $291 | $2,087 | $6,953 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $585 | $2,324 | $6,953 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $591 | $2,574 | $6,953 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $888 | $2,528 | $7,944 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,163 | $2,762 | $7,944 |
| Carpal tunnel release CPT 64721 • Orthopedics | $268 | $1,915 | $6,953 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $74 | $1,524 | $6,953 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $102 | $1,611 | $6,953 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $113 | $1,579 | $6,953 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $94 | $1,611 | $6,953 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $493 | $2,704 | $6,953 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $60 | $1,492 | $6,953 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $17 | $1,431 | $6,953 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $59 | $1,561 | $6,953 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $64 | $1,480 | $6,953 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $76 | $1,524 | $6,953 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $48 | $1,490 | $6,953 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $118 | $1,603 | $6,953 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $183 | $1,757 | $6,953 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $83 | $1,602 | $6,953 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $6,953 | $6,953 | $6,953 |
| Cytopathology concentration technique CPT 88108 • Pathology | $20 | $104 | $235 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $19 | $66 | $128 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $34 | $60 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $20 | $35 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $39 | $61 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $32 | $49 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $51 | $75 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $7 | $38 | $59 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $13 | $58 | $110 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $36 | $83 | $128 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $66 | $254 | $508 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $99 | $410 | $776 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $18 | $110 | $188 |
| Special stain group II CPT 88313 • Pathology | $24 | $112 | $198 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $104 | $181 |
| Frozen section pathology each additional CPT 88332 • Pathology | $13 | $57 | $98 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $93 | $174 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $101 | $204 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $36 | $123 | $266 |
| Microdissection manual CPT 88381 • Pathology | $65 | $188 | $386 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $0 | $8 | $15 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $17 | $29 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $18 | $27 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $20 | $34 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $6 | $18 | $33 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $14 | $39 | $68 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $15 | $44 | $78 |