| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $918 | $918 | $918 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $95 | $95 | $95 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $45 | $75 | $106 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $507 | $507 | $507 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $224 | $224 | $224 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $160 | $266 | $372 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $83 | $138 | $192 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $141 | $207 | $273 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $410 | $571 | $892 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $226 | $273 | $366 |
| Cytopathology concentration technique CPT 88108 • Pathology | $50 | $89 | $128 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $52 | $96 | $140 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $35 | $54 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $22 | $32 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $39 | $57 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $46 | $46 | $46 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $72 | $72 | $72 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $24 | $44 | $63 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $32 | $58 | $85 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $56 | $101 | $146 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $45 | $279 | $569 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $340 | $604 | $867 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $88 | $152 | $217 |
| Special stain group II CPT 88313 • Pathology | $26 | $45 | $63 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $80 | $143 | $206 |
| Frozen section pathology each additional CPT 88332 • Pathology | $42 | $44 | $46 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $69 | $99 | $129 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $79 | $110 | $140 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $33 | $100 | $166 |
| Microdissection manual CPT 88381 • Pathology | $163 | $238 | $313 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $7 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $20 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $18 | $27 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $21 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $20 | $32 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $44 | $67 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $50 | $77 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $43 | $66 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $40 | $62 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $26 | $40 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $68 | $128 | $187 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $68 | $128 | $187 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $187 | $187 | $187 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $88 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $55 | $86 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $48 | $75 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $38 | $73 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $49 | $76 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $70 | $107 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $60 | $91 |