| Office visit established patient moderate complexity CPT 99214 • Office Visits | $48 | $56 | $65 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $46 | $46 | $46 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $67 | $67 | $67 |
| Consultation office low complexity CPT 99243 • Office Visits | $0 | $0 | $0 |
| Consultation office high complexity CPT 99245 • Office Visits | $0 | $0 | $0 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $241 | $452 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $130 | $130 | $130 |
| Cytopathology concentration technique CPT 88108 • Pathology | $16 | $20 | $22 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $34 | $44 | $55 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $12 | $17 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $8 | $10 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $18 | $23 | $27 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $20 | $23 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $20 | $26 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $20 | $24 | $28 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $6 | $23 | $37 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $33 | $52 | $81 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $47 | $149 | $189 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $70 | $150 | $230 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $16 | $46 | $64 |
| Special stain group II CPT 88313 • Pathology | $30 | $37 | $42 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $21 | $36 | $51 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $21 | $24 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $25 | $45 | $59 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $47 | $58 | $68 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $33 | $48 | $64 |
| Microdissection manual CPT 88381 • Pathology | $29 | $60 | $92 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $11 | $11 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $18 | $18 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $60 | $60 | $60 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $21 | $21 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $21 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $102 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $40 | $40 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $47 | $47 | $47 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $77 | $77 | $77 |