| Office visit established patient low complexity CPT 99213 • Office Visits | $88 | $96 | $103 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $156 | $156 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $176 | $176 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $193 | $193 | $193 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $65 | $65 | $65 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $36 | $45 | $53 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $115 | $115 | $115 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,654 | $1,654 | $1,654 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,545 | $1,545 | $1,545 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,801 | $1,801 | $1,801 |
| Total shoulder replacement CPT 23472 • Orthopedics | $2,423 | $2,423 | $2,423 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $582 | $805 | $1,027 |
| Total hip replacement CPT 27130 • Orthopedics | $1,255 | $1,255 | $1,255 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $1,632 | $1,632 | $1,632 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,128 | $1,128 | $1,128 |
| Total knee replacement CPT 27447 • Orthopedics | $1,253 | $1,867 | $2,480 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $865 | $1,015 | $1,166 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $1,081 | $1,081 | $1,081 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,046 | $1,405 | $1,764 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $550 | $550 | $550 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $530 | $772 | $1,014 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $674 | $884 | $1,094 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $1,594 | $1,594 | $1,594 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $949 | $1,210 | $1,472 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,075 | $1,075 | $1,075 |
| Carpal tunnel release CPT 64721 • Orthopedics | $433 | $546 | $659 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $81 | $208 | $335 |
| 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 | $41 | $102 | $163 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $556 | $556 | $556 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $267 | $267 | $267 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $191 | $191 | $191 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $21 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $37 | $37 | $37 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $79 | $79 | $79 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $102 | $102 | $102 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $66 | $66 | $66 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $323 | $323 | $323 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $333 | $333 | $333 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $146 | $146 | $146 |
| Special stain group II CPT 88313 • Pathology | $62 | $84 | $106 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $48 | $99 | $149 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $69 | $70 | $71 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $81 | $118 | $155 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $32 | $111 | $190 |
| 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 | $10 | $21 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $24 | $28 | $31 |