| Sacroiliac joint injection CPT 27096 • Pain Management | $85 | $128 | $171 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $12 | $12 | $12 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $44 | $44 | $44 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $285 | $285 | $285 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $238 | $238 | $238 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $51 | $51 | $51 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $65 | $65 | $65 |
| Microdissection manual CPT 88381 • Pathology | $174 | $174 | $174 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $7 | $7 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $7 | $7 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $8 | $8 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $15 | $15 | $15 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $16 | $16 | $16 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $17 | $17 | $17 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $14 | $14 | $14 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $10 | $10 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $59 | $59 | $59 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $59 | $59 | $59 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $41 | $41 | $41 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $16 | $16 | $16 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $19 | $19 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $19 | $19 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $19 | $19 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $28 | $28 | $28 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $24 | $24 |
| 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 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $335 | $335 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $133 | $133 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $97 | $97 | $97 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $89 | $104 | $119 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $66 | $66 | $66 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $75 | $75 | $75 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $119 | $119 | $120 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $72 | $173 | $275 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $105 | $118 | $131 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $131 | $131 | $131 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $103 | $103 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $117 | $117 | $117 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $159 | $159 | $159 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $209 | $209 | $209 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,584 | $1,584 | $1,584 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $96 | $96 | $96 |
| Spirometry CPT 94010 • Pulmonology | $28 | $28 | $28 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $24 | $24 | $24 |