| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $125 | $177 | $262 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $260 | $307 | $354 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $129 | $151 | $179 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $184 | $242 | $298 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $329 | $717 | $963 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $87 | $293 | $395 |
| Cytopathology concentration technique CPT 88108 • Pathology | $58 | $98 | $129 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $46 | $93 | $140 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $24 | $46 | $68 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $30 | $31 | $32 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $24 | $24 | $24 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $24 | $50 | $77 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $41 | $52 | $63 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $9 | $46 | $84 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $67 | $77 | $87 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $193 | $451 | $614 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $179 | $510 | $840 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $56 | $129 | $202 |
| Special stain group II CPT 88313 • Pathology | $45 | $101 | $142 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $48 | $95 | $166 |
| Frozen section pathology each additional CPT 88332 • Pathology | $33 | $72 | $110 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $53 | $131 | $187 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $33 | $144 | $220 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $47 | $128 | $237 |
| Microdissection manual CPT 88381 • Pathology | $133 | $133 | $133 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $8 | $12 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $20 | $23 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $22 | $27 | $33 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $24 | $34 | $45 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $16 | $22 | $27 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $41 | $54 | $68 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $43 | $61 | $80 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $36 | $50 | $67 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $38 | $54 | $71 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $26 | $26 | $26 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $103 | $136 | $170 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $103 | $144 | $191 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $103 | $136 | $170 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $70 | $96 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $45 | $46 | $47 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $44 | $59 | $73 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $39 | $39 | $39 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $43 | $56 | $69 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $49 | $49 | $50 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $43 | $43 | $43 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $15 | $35 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $17 | $22 | $26 |
| Immunization admin injection single CPT 90471 • Preventive Care | $32 | $48 | $59 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $16 | $21 | $26 |