| Office visit established patient high complexity CPT 99215 • Office Visits | $206 | $206 | $206 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $78 | $78 | $78 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $114 | $114 | $114 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $169 | $169 | $169 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $42 | $42 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $69 | $69 | $69 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $109 | $109 | $109 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $63 | $63 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $111 | $111 | $111 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $46 | $46 | $46 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $49 | $49 | $49 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $34 | $34 | $34 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,537 | $1,537 | $1,537 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $281 | $281 | $281 |
| Total hip replacement CPT 27130 • Orthopedics | $143 | $143 | $143 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $199 | $199 | $199 |
| Total knee replacement CPT 27447 • Orthopedics | $142 | $142 | $142 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $127 | $127 | $127 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $493 | $493 | $493 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $237 | $237 | $237 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $573 | $573 | $573 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $938 | $938 | $938 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $130 | $130 | $130 |
| Carpal tunnel release CPT 64721 • Orthopedics | $187 | $187 | $187 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $147 | $147 | $147 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $230 | $230 | $230 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $85 | $85 | $85 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $44 | $44 | $44 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $122 | $122 | $122 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $149 | $149 | $149 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $72 | $72 | $72 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $13 | $13 |
| 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 | $33 | $33 | $33 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $37 | $37 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $66 | $66 | $66 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $12 | $12 | $12 |
| Special stain group II CPT 88313 • Pathology | $5 | $5 | $5 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $28 | $28 | $28 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $13 | $13 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $16 | $16 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $19 | $19 | $19 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $12 | $12 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $11 | $11 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |