| Sacroiliac joint injection CPT 27096 • Pain Management | $86 | $1,609 | $5,449 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $106 | $1,676 | $5,449 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $75 | $1,152 | $5,449 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $98 | $1,614 | $5,449 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $304 | $3,720 | $7,598 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $1,459 | $5,449 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $28 | $1,421 | $5,449 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $163 | $1,334 | $5,449 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $42 | $1,486 | $5,449 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $84 | $1,204 | $5,449 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $95 | $1,496 | $5,449 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $124 | $1,575 | $5,449 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $178 | $1,914 | $5,449 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $56 | $1,621 | $5,449 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $0 | $3,159 | $5,449 |
| Cytopathology concentration technique CPT 88108 • Pathology | $28 | $110 | $163 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $18 | $101 | $171 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $48 | $70 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $36 | $63 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $53 | $92 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $43 | $74 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $36 | $70 | $108 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $60 | $98 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $73 | $107 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $32 | $118 | $245 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $66 | $471 | $890 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $113 | $765 | $1,354 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $38 | $203 | $347 |
| Special stain group II CPT 88313 • Pathology | $3 | $155 | $251 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $16 | $165 | $322 |
| Frozen section pathology each additional CPT 88332 • Pathology | $8 | $81 | $170 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $11 | $161 | $290 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $12 | $196 | $326 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $31 | $204 | $385 |
| Microdissection manual CPT 88381 • Pathology | $39 | $390 | $631 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $10 | $16 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $21 | $34 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $21 | $34 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $20 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $22 | $34 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $42 | $67 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $48 | $79 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $17 | $41 | $67 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $41 | $62 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $25 | $41 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $65 | $143 | $230 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $142 | $230 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $65 | $144 | $230 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $45 | $97 | $160 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $18 | $49 | $87 |