| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $29 | $29 | $29 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $54 | $54 | $55 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,501 | $1,501 | $1,502 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,199 | $1,199 | $1,199 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $292 | $292 | $292 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,018 | $1,018 | $1,018 |
| Total knee replacement CPT 27447 • Orthopedics | $1,062 | $1,062 | $1,062 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $488 | $488 | $488 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $766 | $766 | $766 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $141 | $141 | $141 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $455 | $455 | $455 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $141 | $141 | $141 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $236 | $236 | $236 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $69 | $69 | $69 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $36 | $36 | $36 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $44 | $44 | $44 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $399 | $399 | $399 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $221 | $221 | $222 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $12 | $12 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $178 | $178 | $178 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $25 | $25 | $25 |
| Microdissection manual CPT 88381 • Pathology | $131 | $131 | $131 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $2 | $2 | $3 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $5 | $5 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $6 | $6 | $6 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $6 | $6 | $6 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $14 | $14 | $14 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $16 | $16 | $16 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $14 | $14 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $12 | $12 | $12 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $8 | $8 | $8 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $33 | $33 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $17 | $17 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $15 | $15 | $15 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $15 | $15 | $15 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $16 | $16 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $23 | $23 | $23 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $19 | $19 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $271 | $271 | $271 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $258 | $258 | $258 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $104 | $104 | $104 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $117 | $117 | $117 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $76 | $76 | $76 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $57 | $57 | $57 |