| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $26 | $26 | $26 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $298 | $298 | $298 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $30 | $30 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $58 | $58 | $58 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $284 | $284 | $284 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $129 | $129 | $129 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $204 | $204 | $204 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $105 | $105 | $105 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $178 | $178 | $178 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $344 | $428 | $511 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $58 | $121 | $183 |
| Cytopathology concentration technique CPT 88108 • Pathology | $48 | $48 | $48 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $49 | $49 | $49 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $13 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $203 | $206 | $210 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $319 | $319 | $319 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $81 | $81 | $81 |
| Special stain group II CPT 88313 • Pathology | $59 | $59 | $59 |
| Frozen section pathology each additional CPT 88332 • Pathology | $40 | $40 | $40 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $63 | $63 | $63 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $73 | $73 | $73 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $92 | $92 | $92 |
| Microdissection manual CPT 88381 • Pathology | $145 | $145 | $145 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $10 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $12 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $28 | $28 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $22 | $22 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $70 | $70 | $70 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $54 | $57 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $30 | $30 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $23 | $23 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $23 | $24 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $23 | $23 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $29 | $29 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $2 | $2 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |