| Office visit established patient low complexity CPT 99213 • Office Visits | $75 | $82 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $125 | $125 | $125 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $212 | $212 | $212 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $69 | $92 | $116 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $116 | $116 | $116 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $522 | $522 | $522 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $63 | $63 | $63 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $258 | $258 | $258 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $255 | $255 | $255 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $74 | $74 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $29 | $42 | $55 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $77 | $77 | $77 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $12 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $12 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $25 | $25 | $25 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $29 | $29 | $29 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $25 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $23 | $23 | $23 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $84 | $84 | $84 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $84 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $84 | $84 | $84 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $58 | $58 | $58 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $27 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $38 | $38 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $338 | $338 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $338 | $338 | $338 |
| Spirometry CPT 94010 • Pulmonology | $8 | $17 | $26 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $10 | $19 | $27 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $11 | $11 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $16 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $40 | $46 | $52 |
| Orchiectomy radical inguinal CPT 54530 • Urology | $496 | $496 | $496 |
| Vasectomy CPT 55250 • Urology | $328 | $328 | $328 |