| Facet joint injection lumbar second level CPT 64494 • Pain Management | $50 | $61 | $84 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $124 | $129 | $138 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $178 | $261 | $413 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $56 | $128 | $240 |
| Cytopathology concentration technique CPT 88108 • Pathology | $10 | $39 | $57 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $41 | $66 | $97 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $12 | $16 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $10 | $13 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $25 | $40 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $15 | $17 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $22 | $27 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $24 | $25 | $26 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $27 | $60 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $36 | $68 | $103 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $90 | $295 | $412 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $160 | $295 | $391 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $11 | $59 | $85 |
| Special stain group II CPT 88313 • Pathology | $5 | $62 | $115 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $65 | $90 |
| Frozen section pathology each additional CPT 88332 • Pathology | $13 | $26 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $75 | $134 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $66 | $151 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $20 | $102 | $178 |
| Microdissection manual CPT 88381 • Pathology | $19 | $79 | $153 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $0 | $3 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $6 | $13 | $27 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $13 | $22 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $17 | $27 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $6 | $16 | $26 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $16 | $29 | $44 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $18 | $41 | $69 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $35 | $60 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $16 | $29 | $41 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $9 | $12 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $65 | $94 | $148 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $65 | $92 | $148 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $71 | $101 | $148 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $44 | $86 | $133 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $36 | $57 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $18 | $35 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $15 | $34 | $48 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $27 | $43 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $20 | $43 | $72 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $37 | $61 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $25 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $11 | $19 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $33 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $16 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $298 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $289 | $364 |