| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $142 | $334 | $697 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $260 | $3,002 | $8,271 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $69 | $341 | $697 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $697 | $697 | $697 |
| Cytopathology concentration technique CPT 88108 • Pathology | $30 | $30 | $30 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $127 | $127 | $127 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $14 | $14 | $14 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $23 | $23 | $23 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $34 | $34 | $34 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $32 | $38 | $44 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $55 | $55 | $55 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $169 | $169 | $169 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $131 | $131 | $131 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $53 | $70 | $86 |
| Special stain group II CPT 88313 • Pathology | $12 | $12 | $12 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $74 | $77 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $36 | $39 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $77 | $77 | $77 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $40 | $59 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $66 | $66 | $66 |
| Microdissection manual CPT 88381 • Pathology | $52 | $52 | $52 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $7 | $9 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $13 | $16 | $18 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $13 | $15 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $15 | $18 | $21 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $16 | $21 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $35 | $44 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $27 | $39 | $50 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $23 | $34 | $44 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $25 | $33 | $40 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $22 | $27 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $93 | $121 | $149 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $93 | $121 | $149 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $93 | $121 | $149 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $63 | $83 | $103 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $41 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $29 | $39 | $48 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $37 | $47 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $39 | $50 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $47 | $70 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $42 | $62 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $20 | $34 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $19 | $30 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $13 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $301 | $326 | $351 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $329 | $400 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $102 | $113 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $103 | $105 | $108 |