| Peripheral nerve block injection CPT 64450 • Pain Management | $40 | $146 | $253 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $89 | $130 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $907 | $907 | $907 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $403 | $403 | $403 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $577 | $577 | $577 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $127 | $127 | $127 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $160 | $276 | $391 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $653 | $653 | $653 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $520 | $520 | $520 |
| Cytopathology concentration technique CPT 88108 • Pathology | $71 | $76 | $81 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $68 | $119 | $171 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $60 | $60 | $60 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $40 | $40 | $40 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $98 | $98 | $98 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $18 | $31 | $55 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $80 | $80 | $80 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $6 | $33 | $60 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $32 | $37 | $42 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $72 | $158 | $243 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $246 | $316 | $417 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $426 | $486 | $545 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $22 | $63 | $105 |
| Special stain group II CPT 88313 • Pathology | $70 | $90 | $128 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $46 | $49 | $52 |
| Frozen section pathology each additional CPT 88332 • Pathology | $24 | $39 | $55 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $97 | $108 | $120 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $80 | $101 | $123 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $35 | $97 | $159 |
| Microdissection manual CPT 88381 • Pathology | $529 | $529 | $529 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $14 | $14 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $14 | $14 | $14 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $15 | $15 | $15 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $12 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $46 | $74 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $34 | $54 | $75 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $64 | $64 | $64 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $69 | $69 | $69 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $45 | $45 | $45 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $219 | $219 | $219 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $219 | $219 | $219 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $219 | $219 | $219 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $148 | $148 | $148 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $76 | $76 | $76 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $78 | $78 | $78 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $72 | $72 | $72 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $75 | $75 | $75 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $79 | $79 | $79 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $73 | $73 | $73 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $28 | $65 |