| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $252 | $252 | $252 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $59 | $59 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $77 | $77 | $77 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $127 | $139 | $150 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $153 | $157 | $161 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $18 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $39 | $39 | $39 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $63 | $63 | $63 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $99 | $99 | $99 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $133 | $133 | $133 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $157 | $157 | $157 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $78 | $78 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $49 | $49 | $49 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $71 | $71 | $71 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $78 | $78 | $78 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $84 | $84 | $84 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $26 | $26 | $26 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $32 | $32 | $32 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $2 | $2 | $2 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $5 | $5 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $6 | $6 | $6 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $12 | $12 | $12 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $14 | $14 | $14 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $11 | $11 | $11 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $15 | $15 | $15 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $13 | $13 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $9 | $9 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $49 | $49 | $49 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $78 | $78 | $78 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $66 | $77 | $89 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $86 | $86 | $86 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $76 | $76 | $76 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $69 | $69 | $69 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $69 | $69 | $69 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $55 | $55 | $55 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $77 | $77 | $77 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $77 | $89 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $91 | $91 | $91 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $16 | $16 | $16 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $101 | $101 | $101 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $7 | $7 | $7 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $8 | $8 | $8 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $33 | $33 | $33 |
| Post-void residual urine measurement CPT 51798 • Urology | $9 | $9 | $9 |