| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $113 | $113 | $113 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $105 | $105 | $105 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $21 | $65 | $100 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $41 | $41 | $41 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $109 | $109 | $109 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $49 | $49 | $49 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $143 | $143 | $143 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $81 | $81 | $81 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $139 | $139 | $139 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $304 | $304 | $304 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $94 | $94 | $94 |
| Cytopathology concentration technique CPT 88108 • Pathology | $91 | $91 | $91 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $16 | $65 | $90 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $13 | $13 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $30 | $30 | $30 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $9 | $16 | $24 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $17 | $43 | $57 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $19 | $70 | $96 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $107 | $289 | $380 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $230 | $379 | $573 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $44 | $114 | $149 |
| Special stain group II CPT 88313 • Pathology | $37 | $85 | $109 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $56 | $90 | $135 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $45 | $73 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $36 | $92 | $120 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $42 | $107 | $140 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $64 | $128 | $160 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $15 | $17 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $11 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $17 | $19 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $17 | $19 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $21 | $34 | $40 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $27 | $39 | $46 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $34 | $40 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $6 | $27 | $37 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $22 | $24 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $91 | $121 | $136 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $73 | $115 | $136 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $116 | $136 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $63 | $83 | $94 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $37 | $49 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $38 | $44 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $33 | $43 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $29 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $38 | $55 | $64 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $28 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $9 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $22 | $26 | $27 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $16 | $18 | $20 |