| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $591 | $591 | $591 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,330 | $1,330 | $1,331 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $97 | $97 | $97 |
| Visual field examination CPT 92083 • Ophthalmology | $40 | $40 | $40 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $48 | $48 | $48 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $48 | $48 | $48 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $76 | $88 | $100 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $3,147 | $3,147 | $3,147 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $2,043 | $2,043 | $2,043 |
| Total knee replacement CPT 27447 • Orthopedics | $2,262 | $2,262 | $2,262 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $941 | $941 | $941 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,429 | $1,429 | $1,429 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $887 | $887 | $887 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $252 | $252 | $252 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $389 | $389 | $389 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $136 | $136 | $136 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $117 | $117 | $117 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $158 | $158 | $158 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $629 | $629 | $629 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $256 | $256 | $256 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $39 | $39 | $39 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $304 | $304 | $304 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $111 | $111 | $111 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $50 | $50 | $50 |
| Microdissection manual CPT 88381 • Pathology | $194 | $194 | $194 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $6 | $7 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $15 | $15 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $13 | $13 | $13 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $16 | $16 | $16 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $15 | $15 | $15 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $33 | $33 | $33 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $38 | $38 | $38 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $33 | $33 | $33 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $30 | $30 | $30 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $20 | $20 | $20 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $92 | $92 | $92 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $92 | $92 | $92 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $63 | $63 | $63 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $42 | $42 | $42 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $36 | $36 | $36 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $36 | $36 | $36 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $37 | $37 | $37 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $52 | $52 | $52 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $45 | $45 | $45 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $18 | $18 | $18 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $9 | $9 |
| 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 |