| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $30 | $313 | $595 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $30 | $30 | $30 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,079 | $1,079 | $1,079 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,159 | $1,159 | $1,159 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,315 | $1,315 | $1,315 |
| Carpal tunnel release CPT 64721 • Orthopedics | $518 | $518 | $518 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $30 | $30 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $128 | $219 | $310 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $305 | $305 | $305 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $30 | $30 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $57 | $57 | $57 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $286 | $286 | $286 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $62 | $62 | $62 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $205 | $205 | $205 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $106 | $106 | $106 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $180 | $180 | $180 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $488 | $488 | $488 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $201 | $201 | $201 |
| Cytopathology concentration technique CPT 88108 • Pathology | $50 | $50 | $50 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $53 | $53 | $53 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $17 | $17 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $23 | $23 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $27 | $27 | $27 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $33 | $33 | $33 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $227 | $227 | $228 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $347 | $347 | $347 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $88 | $88 | $88 |
| Special stain group II CPT 88313 • Pathology | $63 | $63 | $63 |
| Frozen section pathology each additional CPT 88332 • Pathology | $44 | $44 | $44 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $73 | $73 | $73 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $83 | $83 | $83 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $98 | $98 | $98 |
| Microdissection manual CPT 88381 • Pathology | $158 | $158 | $158 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $10 | $10 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $21 | $21 | $21 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $25 | $25 | $25 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $21 | $21 | $21 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $20 | $20 | $20 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $13 | $13 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $50 | $50 | $50 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $27 | $27 |