| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $45 | $488 | $930 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,060 | $1,060 | $1,060 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $557 | $557 | $557 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $45 | $291 | $537 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $941 | $941 | $941 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,067 | $1,067 | $1,067 |
| Carpal tunnel release CPT 64721 • Orthopedics | $434 | $434 | $434 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $45 | $45 | $45 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $108 | $185 | $263 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $151 | $151 | $151 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $259 | $259 | $259 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $45 | $45 | $45 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $48 | $48 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $239 | $239 | $239 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $175 | $175 | $175 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $89 | $89 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $145 | $145 | $145 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $419 | $419 | $420 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $174 | $174 | $174 |
| Cytopathology concentration technique CPT 88108 • Pathology | $43 | $43 | $43 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $47 | $47 | $47 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $18 | $18 | $18 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $10 | $10 | $10 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $18 | $18 | $18 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| 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 | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $196 | $196 | $196 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $298 | $298 | $298 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $74 | $74 | $74 |
| Special stain group II CPT 88313 • Pathology | $53 | $53 | $53 |
| Frozen section pathology each additional CPT 88332 • Pathology | $38 | $38 | $38 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $65 | $65 | $65 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $74 | $74 | $74 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $30 | $30 |
| Microdissection manual CPT 88381 • Pathology | $127 | $127 | $127 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $6 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $14 | $14 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $12 | $12 | $12 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $14 | $14 | $14 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $14 | $14 | $14 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $31 | $31 | $31 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $35 | $35 | $35 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $30 | $30 | $30 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $28 | $28 | $28 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $18 | $18 | $18 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $86 | $86 | $86 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $86 | $86 | $86 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $60 | $60 | $60 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $40 | $40 | $40 |