| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $672 | $731 | $790 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $183 | $372 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $292 | $387 | $482 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $91 | $162 | $222 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $145 | $270 | $418 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $449 | $872 | $1,468 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $188 | $378 | $658 |
| Cytopathology concentration technique CPT 88108 • Pathology | $40 | $98 | $189 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $49 | $75 | $101 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $66 | $66 | $66 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $16 | $34 | $52 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $13 | $46 | $80 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $58 | $58 | $58 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $54 | $74 | $94 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $12 | $15 | $18 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $20 | $71 | $121 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $87 | $146 | $205 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $183 | $417 | $826 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $260 | $755 | $1,250 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $62 | $77 |
| Special stain group II CPT 88313 • Pathology | $21 | $99 | $197 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $97 | $167 | $294 |
| Frozen section pathology each additional CPT 88332 • Pathology | $55 | $71 | $88 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $37 | $95 | $165 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $96 | $126 | $186 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $95 | $106 | $113 |
| Microdissection manual CPT 88381 • Pathology | $45 | $57 | $69 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $8 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $11 | $18 | $24 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $17 | $23 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $25 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $21 | $28 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $36 | $47 | $57 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $66 | $66 | $66 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $41 | $57 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $30 | $42 | $53 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $35 | $35 | $35 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $223 | $223 | $223 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $92 | $151 | $196 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $196 | $196 | $196 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $42 | $88 | $135 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $39 | $55 | $72 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $64 | $64 | $64 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $42 | $62 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $66 | $66 | $66 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $93 | $93 | $93 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $63 | $92 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $30 | $51 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $17 | $23 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $33 | $46 |