| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,182 | $2,182 | $2,182 |
| Total knee replacement CPT 27447 • Orthopedics | $1,651 | $1,651 | $1,651 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $133 | $133 | $133 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $118 | $118 | $118 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $230 | $230 | $230 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $214 | $214 | $214 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $210 | $210 | $210 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $2,004 | $2,004 | $2,004 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $36 | $36 | $36 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $42 | $42 | $42 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $202 | $202 | $202 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $244 | $244 | $244 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $124 | $124 | $124 |
| Cytopathology concentration technique CPT 88108 • Pathology | $10 | $10 | $10 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $3 | $3 | $3 |
| 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 | $47 | $47 | $47 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $103 | $103 | $103 |
| Special stain group II CPT 88313 • Pathology | $15 | $15 | $15 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $120 | $120 | $120 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $141 | $141 | $141 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $53 | $53 | $53 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $12 | $12 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $10 | $10 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $22 | $22 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $13 | $13 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $74 | $74 | $74 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $74 | $74 | $74 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $26 | $26 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $18 | $18 | $18 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $7 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $17 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $268 | $268 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $99 | $99 |
| MMR vaccine CPT 90707 • Preventive Care | $77 | $77 | $77 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $34 | $34 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $157 | $157 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $98 | $98 | $98 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $207 | $207 | $207 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $95 | $95 | $95 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $99 | $99 | $99 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $155 | $155 | $155 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $119 | $119 | $119 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $137 | $137 | $137 |