| Subsequent hospital care low complexity CPT 99231 • Office Visits | $63 | $63 | $63 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $98 | $98 | $98 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $151 | $151 | $151 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $103 | $103 | $103 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $146 | $146 | $146 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $605 | $605 | $605 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $45 | $45 | $45 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $49 | $49 | $49 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $59 | $59 | $59 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,944 | $1,944 | $1,944 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,728 | $1,728 | $1,728 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,745 | $1,745 | $1,745 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $296 | $296 | $296 |
| Total hip replacement CPT 27130 • Orthopedics | $1,376 | $1,376 | $1,376 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,468 | $1,468 | $1,468 |
| Total knee replacement CPT 27447 • Orthopedics | $1,373 | $1,373 | $1,373 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $257 | $257 | $257 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $20 | $20 | $20 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $124 | $124 | $124 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $462 | $462 | $462 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $232 | $232 | $232 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $106 | $106 | $106 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $1,068 | $1,068 | $1,068 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,293 | $1,293 | $1,293 |
| Carpal tunnel release CPT 64721 • Orthopedics | $548 | $548 | $548 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $151 | $151 | $151 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $118 | $118 | $118 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $110 | $110 | $110 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $459 | $459 | $459 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $45 | $45 | $45 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $296 | $296 | $296 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $55 | $55 | $55 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $149 | $149 | $149 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $60 | $60 | $60 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $131 | $131 | $131 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $318 | $318 | $318 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $95 | $95 | $95 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $17 | $17 | $17 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $15 | $15 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $11 | $11 | $11 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $4 | $4 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $7 | $7 | $7 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $15 | $15 | $15 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $51 | $51 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $90 | $90 | $90 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $17 | $17 |
| Special stain group II CPT 88313 • Pathology | $8 | $8 | $8 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $39 | $39 | $39 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $18 | $18 | $18 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $22 | $22 |