| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $187 | $187 | $187 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $631 | $631 | $631 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $322 | $322 | $322 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $578 | $578 | $578 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $1,288 | $1,400 | $1,513 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $534 | $581 | $628 |
| Cytopathology concentration technique CPT 88108 • Pathology | $60 | $60 | $60 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $109 | $109 | $109 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $70 | $70 | $70 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $35 | $35 | $35 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $61 | $61 | $61 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $49 | $49 | $49 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $90 | $90 | $90 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $67 | $67 | $67 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $82 | $82 | $82 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $206 | $206 | $206 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $220 | $546 | $872 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $1,141 | $1,141 | $1,141 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $70 | $70 | $70 |
| Special stain group II CPT 88313 • Pathology | $32 | $32 | $32 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $166 | $166 | $166 |
| Frozen section pathology each additional CPT 88332 • Pathology | $146 | $146 | $146 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $177 | $177 | $177 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $193 | $193 | $193 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $340 | $340 | $340 |
| Microdissection manual CPT 88381 • Pathology | $73 | $73 | $73 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $21 | $22 | $22 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $47 | $47 | $47 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $40 | $40 | $40 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $48 | $48 | $48 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $47 | $47 | $47 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $99 | $99 | $99 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $114 | $114 | $114 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $98 | $98 | $98 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $91 | $91 | $91 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $59 | $59 | $59 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $278 | $278 | $278 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $278 | $278 | $278 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $278 | $278 | $278 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $192 | $195 | $199 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $129 | $129 | $129 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $111 | $111 | $111 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $107 | $109 | $111 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $114 | $114 | $114 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $162 | $162 | $162 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $137 | $137 | $137 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $15 | $46 | $78 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $37 | $37 | $37 |
| Immunization admin injection single CPT 90471 • Preventive Care | $53 | $61 | $70 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $63 | $63 | $63 |