| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $307 | $307 | $307 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $1,134 | $1,134 | $1,134 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $2,427 | $2,427 | $2,427 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $2,554 | $2,554 | $2,554 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $1,740 | $1,740 | $1,740 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $2,013 | $2,013 | $2,013 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $3,284 | $3,284 | $3,284 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $3,101 | $3,101 | $3,101 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $3,930 | $3,930 | $3,930 |
| Carpal tunnel release CPT 64721 • Orthopedics | $821 | $821 | $821 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $419 | $419 | $419 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,430 | $1,430 | $1,430 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $221 | $221 | $221 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $427 | $427 | $427 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $399 | $399 | $399 |
| Cytopathology concentration technique CPT 88108 • Pathology | $47 | $47 | $47 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $39 | $39 | $39 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $8 | $8 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $7 | $7 | $7 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $5 | $5 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $14 | $14 | $14 |
| 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 | $143 | $143 | $143 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $119 | $119 | $119 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $36 | $36 | $36 |
| Special stain group II CPT 88313 • Pathology | $21 | $21 | $21 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $19 | $19 | $19 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $42 | $42 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $26 | $26 | $26 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $15 | $15 | $15 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $23 | $23 | $23 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $29 | $29 | $29 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $24 | $24 | $24 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $18 | $18 | $18 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $50 | $50 | $50 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $40 | $40 | $40 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $41 | $41 | $41 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $44 | $44 | $44 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $32 | $32 | $32 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $49 | $49 | $49 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $43 | $43 | $43 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $29 | $29 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $34 | $34 | $34 |
| Immunization admin injection single CPT 90471 • Preventive Care | $13 | $13 | $13 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $7 | $7 | $7 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $272 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $19 | $19 | $19 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $35 | $35 | $35 |