| Office visit new patient high complexity CPT 99205 • Office Visits | $339 | $339 | $339 |
| Office visit established patient minimal CPT 99211 • Office Visits | $38 | $38 | $38 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $86 | $86 | $86 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $150 | $150 | $150 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $197 | $197 | $197 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $276 | $276 | $276 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $126 | $126 | $126 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $169 | $169 | $169 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $249 | $249 | $249 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $75 | $75 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $121 | $121 | $121 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $170 | $170 | $170 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $105 | $105 | $105 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $169 | $169 | $169 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $87 | $87 | $87 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $89 | $89 | $89 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $147 | $147 | $147 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $528 | $528 | $528 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $454 | $454 | $454 |
| Total hip replacement CPT 27130 • Orthopedics | $1,794 | $1,794 | $1,794 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,727 | $1,727 | $1,727 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $1,743 | $1,743 | $1,743 |
| Total knee replacement CPT 27447 • Orthopedics | $1,944 | $1,944 | $1,944 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $258 | $258 | $258 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $1,624 | $1,624 | $1,624 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $797 | $797 | $797 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $1,054 | $1,054 | $1,054 |
| Carpal tunnel release CPT 64721 • Orthopedics | $653 | $653 | $653 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $65 | $65 | $65 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $79 | $79 | $79 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $549 | $549 | $549 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $183 | $183 | $183 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $238 | $238 | $238 |
| Cytopathology concentration technique CPT 88108 • Pathology | $109 | $109 | $109 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $194 | $194 | $194 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $37 | $37 | $37 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $25 | $25 | $25 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $62 | $62 | $62 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $34 | $34 | $34 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $44 | $44 | $44 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $71 | $71 | $71 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $94 | $94 | $94 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $69 | $69 | $69 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $169 | $232 | $295 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $413 | $413 | $413 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $126 | $126 | $126 |
| Special stain group II CPT 88313 • Pathology | $90 | $90 | $90 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $109 | $127 | $145 |
| Frozen section pathology each additional CPT 88332 • Pathology | $67 | $67 | $67 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $46 | $46 | $46 |