| Peripheral nerve block injection CPT 64450 • Pain Management | $125 | $209 | $293 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $63 | $87 | $110 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $499 | $509 | $519 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $80 | $139 | $198 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $395 | $410 | $425 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $157 | $179 | $201 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $197 | $269 | $341 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $644 | $796 | $947 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $228 | $251 | $275 |
| Cytopathology concentration technique CPT 88108 • Pathology | $28 | $92 | $157 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $43 | $99 | $155 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $15 | $43 | $71 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $22 | $22 | $22 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $18 | $18 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $18 | $44 | $69 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $33 | $44 | $54 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $35 | $67 | $99 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $28 | $75 | $122 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $130 | $400 | $670 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $99 | $559 | $1,018 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $57 | $134 | $212 |
| Special stain group II CPT 88313 • Pathology | $9 | $78 | $148 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $44 | $93 | $142 |
| Frozen section pathology each additional CPT 88332 • Pathology | $28 | $69 | $110 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $36 | $115 | $194 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $32 | $131 | $231 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $36 | $149 | $262 |
| Microdissection manual CPT 88381 • Pathology | $35 | $35 | $35 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $17 | $17 | $17 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $16 | $16 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $18 | $18 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $13 | $13 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $31 | $31 | $31 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $33 | $33 | $33 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $28 | $28 | $28 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $29 | $29 | $29 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $20 | $20 | $20 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $98 | $98 | $98 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $98 | $98 | $98 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $98 | $98 | $98 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $67 | $67 | $67 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $33 | $33 | $33 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $34 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $31 | $31 | $31 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $34 | $34 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $28 | $28 | $28 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $28 | $28 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $31 | $43 | $54 |