| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $746 | $746 | $746 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $920 | $920 | $920 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $843 | $843 | $843 |
| Carpal tunnel release CPT 64721 • Orthopedics | $505 | $505 | $505 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $245 | $245 | $246 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $302 | $302 | $303 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $292 | $292 | $292 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $534 | $534 | $534 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $225 | $225 | $225 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $177 | $177 | $177 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $70 | $70 | $70 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $96 | $96 | $96 |
| Microdissection manual CPT 88381 • Pathology | $144 | $144 | $144 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $13 | $13 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $16 | $16 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $16 | $16 | $16 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $27 | $27 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $29 | $29 | $29 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $24 | $24 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $26 | $26 | $26 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $17 | $17 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $30 | $30 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $30 | $30 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $29 | $29 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $32 | $32 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $29 | $29 |
| 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 | $5 | $5 | $5 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $118 | $118 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $138 | $138 | $138 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $160 | $160 | $160 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $120 | $120 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $148 | $148 | $148 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $174 | $174 | $174 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $275 | $388 | $501 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $184 | $184 | $184 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $201 | $201 | $201 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $134 | $134 | $134 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $348 | $348 | $348 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $348 | $348 | $348 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $112 | $112 | $112 |
| Spirometry CPT 94010 • Pulmonology | $50 | $50 | $50 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $20 | $20 | $20 |