| Peripheral nerve block injection CPT 64450 • Pain Management | $56 | $149 | $277 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $134 | $156 | $178 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $298 | $507 | $807 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $121 | $248 | $324 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $170 | $349 | $635 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $99 | $186 | $320 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $181 | $345 | $528 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $765 | $1,161 | $1,538 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $113 | $463 | $644 |
| Cytopathology concentration technique CPT 88108 • Pathology | $29 | $50 | $72 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $36 | $61 | $103 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $25 | $31 | $39 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $16 | $18 | $20 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $23 | $31 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $19 | $22 | $25 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $30 | $36 | $41 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $9 | $28 | $48 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $12 | $29 | $61 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $36 | $38 | $39 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $91 | $174 | $221 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $159 | $222 | $316 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $29 | $72 | $98 |
| Special stain group II CPT 88313 • Pathology | $13 | $33 | $71 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $29 | $52 | $81 |
| Frozen section pathology each additional CPT 88332 • Pathology | $40 | $47 | $60 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $37 | $50 | $63 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $84 | $98 | $110 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $46 | $89 | $121 |
| Microdissection manual CPT 88381 • Pathology | $192 | $202 | $212 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $17 | $17 | $17 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $18 | $26 | $33 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $23 | $32 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $31 | $35 | $39 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $15 | $27 | $39 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $38 | $59 | $80 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $44 | $68 | $91 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $34 | $57 | $80 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $31 | $52 | $74 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $48 | $48 | $48 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $106 | $189 | $272 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $106 | $189 | $272 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $106 | $189 | $272 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $72 | $130 | $188 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $49 | $75 | $100 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $89 | $89 | $89 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $86 | $86 | $86 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $43 | $67 | $91 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $130 | $130 | $130 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $112 | $112 | $112 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $29 | $60 |