| Sacroiliac joint injection CPT 27096 • Pain Management | $32 | $254 | $463 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $255 | $469 | $903 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $241 | $414 | $903 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $191 | $454 | $903 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,215 | $2,665 | $7,025 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $21 | $244 | $903 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $33 | $114 | $360 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $313 | $479 | $903 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $158 | $360 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $264 | $420 | $903 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $50 | $175 | $360 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $250 | $366 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $385 | $1,737 | $5,282 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $205 | $1,008 | $5,282 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $360 | $2,821 | $5,281 |
| Cytopathology concentration technique CPT 88108 • Pathology | $35 | $42 | $49 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $12 | $39 | $51 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $16 | $19 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $13 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $19 | $21 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $3 | $15 | $20 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $36 | $36 | $36 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $24 | $25 | $27 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $16 | $26 | $32 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $33 | $47 | $55 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $128 | $215 | $307 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $91 | $273 | $333 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $21 | $39 | $86 |
| Special stain group II CPT 88313 • Pathology | $5 | $35 | $62 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $16 | $37 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $31 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $50 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $58 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $19 | $55 | $94 |
| Microdissection manual CPT 88381 • Pathology | $503 | $503 | $503 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $9 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $11 | $15 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $12 | $15 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $13 | $19 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $12 | $14 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $29 | $50 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $32 | $51 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $31 | $57 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $31 | $53 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $15 | $17 | $25 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $74 | $97 | $170 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $75 | $111 | $196 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $104 | $196 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $51 | $68 | $117 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $38 | $59 |