| Facet joint injection lumbar second level CPT 64494 • Pain Management | $75 | $75 | $75 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $416 | $416 | $416 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $228 | $228 | $228 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $42 | $42 | $42 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $335 | $335 | $335 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $58 | $58 | $58 |
| Microdissection manual CPT 88381 • Pathology | $161 | $161 | $161 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $8 | $8 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $9 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $11 | $11 |
| 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 | $26 | $26 | $26 |
| 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 | $13 | $13 | $13 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $50 | $52 | $55 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $29 | $29 | $29 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $23 | $23 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $24 | $25 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $24 | $24 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $33 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $30 | $30 | $30 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $5 | $5 | $5 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $133 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $219 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $79 | $79 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $128 | $128 | $129 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $71 | $71 | $71 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $97 | $97 | $97 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $313 | $313 | $313 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $154 | $154 | $154 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $151 | $156 | $162 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $150 | $150 | $150 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $122 | $122 | $122 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $302 | $302 | $302 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $90 | $90 | $90 |
| Spirometry CPT 94010 • Pulmonology | $28 | $28 | $28 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $58 | $58 | $58 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $45 | $45 | $45 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $60 | $60 | $60 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $26 | $26 | $26 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $160 | $160 | $160 |