| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $45 | $431 | $817 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $78 | $125 | $173 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $301 | $301 | $301 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $302 | $302 | $302 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $508 | $508 | $508 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $508 | $988 | $1,468 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $144 | $407 | $800 |
| Cytopathology concentration technique CPT 88108 • Pathology | $58 | $58 | $58 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $101 | $101 | $101 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $60 | $60 | $60 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $47 | $47 | $47 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $72 | $72 | $72 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $38 | $58 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $85 | $85 | $85 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $18 | $18 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $80 | $80 | $80 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $27 | $62 | $97 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $328 | $430 | $532 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $376 | $376 | $376 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $289 | $289 | $289 |
| Special stain group II CPT 88313 • Pathology | $178 | $178 | $178 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $161 | $161 | $161 |
| Frozen section pathology each additional CPT 88332 • Pathology | $63 | $63 | $63 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $73 | $73 | $73 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $168 | $168 | $168 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $32 | $70 | $109 |
| Microdissection manual CPT 88381 • Pathology | $62 | $91 | $119 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $9 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $18 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $17 | $26 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $21 | $32 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $19 | $32 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $16 | $41 | $65 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $21 | $48 | $75 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $42 | $65 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $16 | $38 | $60 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $25 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $223 | $223 | $223 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $48 | $135 | $223 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $128 | $176 | $223 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $34 | $74 | $154 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $53 | $82 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $17 | $45 | $73 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $36 | $71 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $49 | $75 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $71 | $89 | $106 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $55 | $92 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $29 | $53 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $21 | $30 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $34 | $53 |