| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $38 | $45 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $49 | $58 | $68 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $30 | $30 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $239 | $239 | $239 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $89 | $106 | $124 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $150 | $150 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $379 | $379 | $379 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $204 | $204 | $204 |
| Cytopathology concentration technique CPT 88108 • Pathology | $49 | $57 | $64 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $27 | $27 | $27 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $14 | $16 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $25 | $28 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $73 | $73 | $73 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $182 | $182 | $182 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $436 | $436 | $436 |
| Special stain group II CPT 88313 • Pathology | $62 | $62 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $79 | $79 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $57 | $57 | $57 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $68 | $68 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $77 | $77 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $46 | $69 | $93 |
| Microdissection manual CPT 88381 • Pathology | $185 | $185 | $185 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $12 | $13 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $11 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $13 | $13 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $12 | $13 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $27 | $27 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $31 | $31 | $31 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $26 | $27 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $25 | $25 | $25 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $16 | $16 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $77 | $80 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $77 | $77 | $77 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $56 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $35 | $35 | $35 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $30 | $30 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $25 | $28 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $31 | $31 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $44 | $44 | $44 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $36 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $18 | $18 | $18 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $9 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $335 | $335 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $98 | $104 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $97 | $100 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $179 | $195 |