| Carpal tunnel release CPT 64721 • Orthopedics | $586 | $586 | $586 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $329 | $329 | $329 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $121 | $121 | $121 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $357 | $357 | $357 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $596 | $596 | $596 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $66 | $66 | $66 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $160 | $160 | $160 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $114 | $114 | $114 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $351 | $351 | $351 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $108 | $108 | $108 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $199 | $199 | $199 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $318 | $318 | $318 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $86 | $86 | $86 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $58 | $58 | $58 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $19 | $19 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $18 | $18 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $18 | $18 | $18 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $37 | $37 | $37 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $48 | $48 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $37 | $37 | $37 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $34 | $34 | $34 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $117 | $117 | $117 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $117 | $117 | $117 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $117 | $117 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $80 | $80 | $80 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $54 | $54 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $47 | $47 | $47 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $48 | $48 | $48 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $19 | $19 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $17 | $17 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $328 | $328 | $328 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $101 | $101 |
| MMR vaccine CPT 90707 • Preventive Care | $105 | $105 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $59 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $199 | $199 | $199 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $221 | $221 | $221 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $148 | $148 | $148 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $155 | $155 | $155 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $105 | $157 | $210 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $105 | $146 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $105 | $168 | $230 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $137 | $209 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $227 | $227 | $227 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $133 | $133 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $145 | $145 | $145 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $181 | $181 | $181 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $156 | $156 | $156 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $71 | $117 | $163 |