| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $109 | $136 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $174 | $238 |
| Consultation office straightforward CPT 99241 • Office Visits | $49 | $49 | $49 |
| Consultation office low complexity CPT 99243 • Office Visits | $92 | $154 | $217 |
| Consultation office high complexity CPT 99245 • Office Visits | $146 | $322 | $499 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $129 | $129 | $129 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $91 | $91 | $91 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $157 | $157 | $157 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $5,459 | $5,459 | $5,459 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $5,100 | $5,100 | $5,100 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $5,943 | $5,943 | $5,943 |
| Total shoulder replacement CPT 23472 • Orthopedics | $3,521 | $3,521 | $3,521 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $3,924 | $3,924 | $3,924 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $1,026 | $1,026 | $1,026 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $792 | $792 | $792 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $709 | $709 | $709 |
| Total hip replacement CPT 27130 • Orthopedics | $3,124 | $3,124 | $3,124 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $4,062 | $4,062 | $4,062 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $2,904 | $2,904 | $2,904 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $2,987 | $2,987 | $2,987 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $2,985 | $2,985 | $2,985 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $2,808 | $2,808 | $2,808 |
| Total knee replacement CPT 27447 • Orthopedics | $3,121 | $3,121 | $3,121 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $1,415 | $1,415 | $1,415 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $770 | $770 | $770 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $2,153 | $2,153 | $2,153 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $421 | $421 | $421 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $2,604 | $2,604 | $2,604 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $1,370 | $1,370 | $1,370 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $1,319 | $1,319 | $1,319 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,679 | $1,679 | $1,679 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $2,381 | $2,381 | $2,381 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $3,131 | $3,131 | $3,131 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $3,549 | $3,549 | $3,549 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $201 | $201 | $201 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $853 | $853 | $853 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $263 | $263 | $263 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $840 | $840 | $840 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $7,550 | $7,550 | $7,550 |
| Cytopathology concentration technique CPT 88108 • Pathology | $81 | $81 | $81 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $84 | $84 | $84 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $28 | $28 | $28 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $21 | $21 | $21 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $35 | $35 | $35 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $28 | $28 | $28 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $43 | $43 | $43 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $40 | $40 | $40 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $52 | $52 | $52 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $91 | $91 | $91 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $361 | $361 | $361 |