| Peripheral nerve block injection CPT 64450 • Pain Management | $125 | $1,280 | $2,712 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $73 | $1,042 | $1,663 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $325 | $1,539 | $2,712 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $159 | $983 | $1,663 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $255 | $1,513 | $2,712 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $129 | $978 | $1,663 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $223 | $1,087 | $1,663 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $618 | $2,584 | $6,142 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $276 | $1,171 | $1,663 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $930 | $1,349 | $1,663 |
| Cytopathology concentration technique CPT 88108 • Pathology | $32 | $65 | $89 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $32 | $77 | $117 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $19 | $38 | $51 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $29 | $39 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $24 | $54 | $81 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $47 | $66 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $44 | $57 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $31 | $63 | $88 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $34 | $67 | $109 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $48 | $72 | $142 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $96 | $246 | $367 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $132 | $278 | $355 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $44 | $90 | $129 |
| Special stain group II CPT 88313 • Pathology | $22 | $75 | $111 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $21 | $62 | $97 |
| Frozen section pathology each additional CPT 88332 • Pathology | $7 | $26 | $45 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $33 | $91 | $114 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $42 | $86 | $113 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $48 | $97 | $135 |
| Microdissection manual CPT 88381 • Pathology | $101 | $158 | $205 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $8 | $10 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $21 | $24 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $20 | $26 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $24 | $26 | $26 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $18 | $22 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $42 | $45 | $50 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $44 | $48 | $57 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $40 | $43 | $49 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $39 | $42 | $45 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $29 | $29 | $30 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $111 | $132 | $150 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $137 | $142 | $150 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $110 | $137 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $75 | $95 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $52 | $55 | $65 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $48 | $50 | $55 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $41 | $54 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $42 | $57 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $50 | $62 | $77 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $50 | $66 |