| Office visit new patient high complexity CPT 99205 • Office Visits | $219 | $219 | $219 |
| Office visit established patient minimal CPT 99211 • Office Visits | $25 | $25 | $25 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $54 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $94 | $94 | $94 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $106 | $106 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $162 | $162 | $162 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $87 | $87 | $87 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $119 | $119 | $119 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $158 | $158 | $158 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $38 | $38 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $87 | $87 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $96 | $96 | $96 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $141 | $141 | $141 |
| Consultation office low complexity CPT 99243 • Office Visits | $112 | $112 | $112 |
| Consultation office high complexity CPT 99245 • Office Visits | $197 | $197 | $197 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $257 | $257 | $257 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $436 | $436 | $436 |
| Visual field examination CPT 92083 • Ophthalmology | $59 | $59 | $59 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $72 | $72 | $72 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,354 | $1,354 | $1,354 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $134 | $134 | $134 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $11 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $12 | $12 | $12 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $3 | $3 | $3 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $5 | $5 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $17 | $17 | $17 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $36 | $36 | $36 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $52 | $52 | $52 |
| Special stain group II CPT 88313 • Pathology | $5 | $5 | $5 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $41 | $69 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $16 | $16 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $19 | $19 | $19 |
| Microdissection manual CPT 88381 • Pathology | $236 | $236 | $236 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $11 | $21 | $31 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $30 | $30 | $30 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $35 | $35 | $35 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $18 | $26 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $41 | $61 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $43 | $64 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $38 | $54 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $38 | $58 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $38 | $38 | $38 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $98 | $98 | $98 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $73 | $73 | $73 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $48 | $64 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $43 | $65 |