| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $365 | $1,243 | $3,000 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $365 | $1,612 | $4,000 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $650 | $1,767 | $4,000 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $650 | $1,767 | $4,000 |
| Carpal tunnel release CPT 64721 • Orthopedics | $365 | $890 | $1,906 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $180 | $273 | $320 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $365 | $430 | $559 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $320 | $400 | $559 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $320 | $415 | $559 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $400 | $1,600 | $4,000 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $320 | $415 | $559 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $180 | $303 | $365 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $365 | $430 | $559 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $180 | $288 | $365 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $320 | $415 | $559 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $180 | $288 | $365 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $180 | $303 | $365 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $320 | $864 | $1,906 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $180 | $303 | $365 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $180 | $288 | $365 |
| Cytopathology concentration technique CPT 88108 • Pathology | $14 | $14 | $14 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $24 | $24 | $24 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $16 | $16 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $13 | $13 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $4 | $4 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $24 | $24 | $24 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $52 | $52 | $52 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $257 | $257 | $257 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $17 | $17 |
| Special stain group II CPT 88313 • Pathology | $46 | $46 | $46 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $39 | $39 |
| Frozen section pathology each additional CPT 88332 • Pathology | $33 | $33 | $33 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $57 | $57 | $57 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $42 | $42 | $42 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $26 | $26 |
| Microdissection manual CPT 88381 • Pathology | $110 | $110 | $110 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $6 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $13 | $13 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $11 | $11 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $13 | $13 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $13 | $13 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $27 | $27 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $31 | $31 | $31 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $26 | $26 | $26 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $25 | $25 | $25 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $16 | $16 |