| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $365 | $1,479 | $4,000 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $549 | $1,223 | $3,000 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $549 | $1,088 | $3,000 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $365 | $1,119 | $3,000 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $470 | $1,395 | $4,000 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $650 | $1,746 | $4,000 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $650 | $1,746 | $4,000 |
| Carpal tunnel release CPT 64721 • Orthopedics | $400 | $817 | $1,906 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $50 | $265 | $365 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $320 | $450 | $642 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $320 | $471 | $642 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $365 | $483 | $642 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $365 | $1,613 | $4,000 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $320 | $416 | $559 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $50 | $240 | $365 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $365 | $427 | $559 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $180 | $332 | $419 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $365 | $427 | $559 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $180 | $332 | $419 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $50 | $240 | $365 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $365 | $781 | $1,906 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $180 | $339 | $419 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $180 | $377 | $642 |
| Cytopathology concentration technique CPT 88108 • Pathology | $21 | $21 | $21 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $31 | $31 | $31 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $22 | $22 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $16 | $16 | $16 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $33 | $33 | $33 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $34 | $34 | $34 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $104 | $104 | $104 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $73 | $73 | $73 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $45 | $45 | $45 |
| Special stain group II CPT 88313 • Pathology | $32 | $32 | $32 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $13 | $13 | $13 |
| Frozen section pathology each additional CPT 88332 • Pathology | $5 | $5 | $5 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $40 | $40 | $40 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $51 | $51 | $51 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $36 | $36 | $36 |
| Microdissection manual CPT 88381 • Pathology | $31 | $31 | $31 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $3 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $11 | $11 | $11 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $11 | $11 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $12 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $9 | $9 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $31 | $31 | $31 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $32 | $32 | $32 |