| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $30 | $30 | $30 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $1,104 | $1,104 | $1,104 |
| Total knee replacement CPT 27447 • Orthopedics | $1,154 | $1,154 | $1,154 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $523 | $523 | $523 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $795 | $795 | $795 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $155 | $155 | $155 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $488 | $488 | $488 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $76 | $111 | $146 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $136 | $182 | $227 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $36 | $36 | $36 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $384 | $384 | $384 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $211 | $219 | $226 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $5 | $5 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $45 | $45 | $45 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $49 | $49 | $49 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $94 | $94 | $94 |
| Microdissection manual CPT 88381 • Pathology | $163 | $163 | $163 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $8 | $8 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $9 | $9 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $9 | $9 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $23 | $23 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $18 | $18 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $69 | $69 | $69 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $48 | $48 | $48 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $25 | $25 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $22 | $22 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $22 | $22 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $33 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $28 | $28 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $2 | $2 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $335 | $335 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $133 | $133 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $97 | $97 | $97 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $119 | $119 | $119 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $87 | $87 | $87 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $66 | $66 | $66 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $103 | $103 | $103 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $120 | $120 | $120 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $311 | $311 | $311 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $311 | $311 | $311 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $149 | $149 | $150 |