| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $266 | $266 | $266 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $80 | $80 | $80 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $112 | $112 | $112 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $65 | $65 | $65 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $173 | $173 | $173 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $545 | $545 | $545 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $77 | $77 | $77 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $106 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $111 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $116 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $131 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $127 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $148 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $124 | $124 | $124 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $96 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $112 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $123 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $99 | $99 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $34 | $34 | $34 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $85 | $85 | $85 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $186 | $186 | $186 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $349 | $349 | $349 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $88 | $88 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $165 | $165 | $165 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $110 | $110 | $110 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $196 | $196 | $196 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $280 | $280 | $280 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $276 | $276 | $276 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $258 | $258 | $258 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $350 | $350 | $350 |
| CPAP combination oral/nasal mask HCPCS A7027 • Sleep Medicine | $185 | $185 | $185 |
| Laparoscopic partial nephrectomy CPT 50543 • Urology | $1,558 | $1,558 | $1,558 |
| Laparoscopic radical nephrectomy CPT 50545 • Urology | $1,515 | $1,515 | $1,515 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $813 | $813 | $813 |
| Complex uroflowmetry CPT 51741 • Urology | $11 | $11 | $11 |
| Post-void residual urine measurement CPT 51798 • Urology | $22 | $22 | $22 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $165 | $165 | $165 |
| Cystourethroscopy with tumor fulguration small CPT 52234 • Urology | $427 | $427 | $427 |
| Cystourethroscopy with tumor fulguration medium CPT 52235 • Urology | $508 | $508 | $508 |
| Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology | $248 | $248 | $248 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $504 | $504 | $504 |
| Cystourethroscopy with lithotripsy CPT 52353 • Urology | $552 | $552 | $552 |
| TURP transurethral resection of prostate CPT 52601 • Urology | $976 | $976 | $976 |
| Laser vaporization of prostate CPT 52648 • Urology | $922 | $922 | $922 |
| Circumcision CPT 54150 • Urology | $149 | $149 | $149 |
| Orchiectomy simple CPT 54520 • Urology | $425 | $425 | $425 |
| Orchiectomy radical inguinal CPT 54530 • Urology | $649 | $649 | $649 |