| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $138 | $432 | $726 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $145 | $232 | $319 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $509 | $520 | $532 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $109 | $186 | $262 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $186 | $296 | $406 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $630 | $857 | $1,236 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $74 | $353 | $688 |
| Cytopathology concentration technique CPT 88108 • Pathology | $38 | $118 | $198 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $55 | $127 | $199 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $26 | $47 | $67 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $15 | $30 | $44 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $16 | $42 | $68 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $34 | $55 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $35 | $63 | $92 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $56 | $93 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $12 | $66 | $120 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $71 | $83 | $95 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $195 | $471 | $819 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $153 | $692 | $1,231 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $64 | $192 | $319 |
| Special stain group II CPT 88313 • Pathology | $8 | $121 | $234 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $65 | $93 | $120 |
| Frozen section pathology each additional CPT 88332 • Pathology | $32 | $91 | $150 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $94 | $169 | $243 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $37 | $159 | $281 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $50 | $78 | $106 |
| Microdissection manual CPT 88381 • Pathology | $173 | $376 | $579 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $14 | $18 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $33 | $35 | $38 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $31 | $32 | $32 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $38 | $38 | $39 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $39 | $40 | $40 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $80 | $82 | $85 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $91 | $97 | $102 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $31 | $55 | $79 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $29 | $51 | $73 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $19 | $33 | $47 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $241 | $256 | $271 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $223 | $247 | $271 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $88 | $179 | $271 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $83 | $145 | $189 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $102 | $106 | $110 |
| 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 | $25 | $48 | $86 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $92 | $97 | $101 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $51 | $92 | $134 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $115 | $116 | $117 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $42 | $52 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $19 | $28 | $37 |
| Immunization admin injection single CPT 90471 • Preventive Care | $41 | $45 | $52 |