| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $752 | $1,315 | $1,879 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $1,410 | $1,457 | $1,503 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $704 | $803 | $902 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $277 | $545 | $813 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $1,804 | $2,167 | $2,349 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $574 | $800 | $924 |
| Cytopathology concentration technique CPT 88108 • Pathology | $71 | $71 | $71 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $71 | $71 | $71 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $45 | $45 | $45 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $23 | $23 | $23 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $40 | $40 | $40 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $32 | $32 | $32 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $59 | $59 | $59 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $12 | $12 | $12 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $20 | $52 | $84 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $69 | $95 | $122 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $347 | $347 | $347 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $252 | $252 | $252 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $178 | $183 | $187 |
| Special stain group II CPT 88313 • Pathology | $21 | $73 | $126 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $63 | $63 | $63 |
| Frozen section pathology each additional CPT 88332 • Pathology | $95 | $95 | $95 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $115 | $115 | $115 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $186 | $186 | $186 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $221 | $221 | $221 |
| Microdissection manual CPT 88381 • Pathology | $322 | $322 | $322 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $15 | $15 | $15 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $32 | $32 | $32 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $61 | $61 | $61 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $32 | $32 | $32 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $32 | $32 | $32 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $68 | $68 | $68 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $78 | $78 | $78 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $67 | $67 | $67 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $62 | $62 | $62 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $40 | $40 | $40 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $189 | $189 | $189 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $189 | $189 | $189 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $189 | $189 | $189 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $130 | $130 | $130 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $88 | $88 | $88 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $76 | $76 | $76 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $73 | $73 | $73 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $77 | $77 | $77 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $110 | $110 | $110 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $93 | $93 | $93 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $31 | $31 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $28 | $28 | $28 |
| Immunization admin injection single CPT 90471 • Preventive Care | $31 | $32 | $32 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $28 | $28 | $28 |