| Carpal tunnel release CPT 64721 • Orthopedics | $657 | $657 | $657 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $860 | $860 | $860 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $47 | $47 | $47 |
| Cytopathology concentration technique CPT 88108 • Pathology | $138 | $138 | $138 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $49 | $49 | $49 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $64 | $64 | $64 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $99 | $99 | $99 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $202 | $202 | $202 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $293 | $293 | $293 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $22 | $22 | $22 |
| Special stain group II CPT 88313 • Pathology | $22 | $22 | $22 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $94 | $94 | $94 |
| Frozen section pathology each additional CPT 88332 • Pathology | $49 | $49 | $49 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $49 | $49 | $49 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $28 | $28 | $28 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $28 | $28 | $28 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $28 | $28 | $28 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $35 | $35 | $35 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $35 | $35 | $35 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $35 | $35 | $35 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $35 | $35 | $35 |
| MMR vaccine CPT 90707 • Preventive Care | $29 | $29 | $29 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $16 | $16 | $16 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $32 | $32 | $32 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $32 | $32 | $32 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $43 | $43 | $43 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $54 | $54 | $54 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $64 | $64 | $64 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $70 | $70 | $70 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $80 | $80 | $80 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $32 | $32 | $32 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $32 | $32 | $32 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $36 | $36 | $36 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $44 | $44 | $44 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $43 | $43 | $43 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $48 | $48 | $48 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $59 | $59 | $59 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $500 | $500 | $500 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $639 | $639 | $639 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $661 | $661 | $661 |
| Spirometry CPT 94010 • Pulmonology | $56 | $56 | $56 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $107 | $107 | $107 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $187 | $187 | $187 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $80 | $80 | $80 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $24 | $24 | $24 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $45 | $45 | $45 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $43 | $43 | $43 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $54 | $54 | $54 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $113 | $113 | $113 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $144 | $144 | $144 |