| Code | Description | Price | Price Type | Last Updated |
|---|---|---|---|---|
| 29240 | Strap Shoulder LT * | $115 [source] | — | 4 years ago |
| 99211 | VISIT ESTABLISHED LEVEL 1 * | $29 [source] | — | 4 years ago |
| 99212 | VISIT ESTABLISHED LEVEL 2 * | $36 [source] | — | 4 years ago |
| 99213 | VISIT ESTABLISHED LEVEL 3 * | $67 [source] | — | 4 years ago |
| 99214 | VISIT ESTABLISHED LEVEL 4 * | $101 [source] | — | 4 years ago |
| C1725 | Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) * | $35 [source] | — | 4 years ago |
| C1776 | Joint device (implantable) * | $55 [source] | — | 4 years ago |
| C1821 | Interspinous process distraction device (implantable) * | $10,603 [source] | — | 4 years ago |
| C1874 | Stent, coated/covered, with delivery system * | $275 [source] | — | 4 years ago |
| C1876 | Stent, non-coated/non-covered, with delivery system * | $126 [source] | — | 4 years ago |
| V2632 | Posterior chamber intraocular lens * | $92 [source] | — | 4 years ago |
| V2787 | Astigmatism correcting function of intraocular lens * | $346 [source] | — | 4 years ago |