| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $80 | $80 | $80 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $247 | $247 | $247 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $533 | $533 | $533 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $80 | $80 | $80 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $125 | $125 | $125 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $54 | $54 | $54 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $470 | $470 | $470 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $242 | $242 | $242 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $80 | $80 | $80 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $178 | $178 | $178 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $258 | $258 | $258 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $80 | $80 | $80 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $80 | $80 | $80 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $80 | $80 | $80 |
| Cytopathology concentration technique CPT 88108 • Pathology | $33 | $33 | $33 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $111 | $111 | $111 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $80 | $80 | $80 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $80 | $80 | $80 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $38 | $38 | $38 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $24 | $24 | $24 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $80 | $80 | $80 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $80 | $80 | $80 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $33 | $33 | $33 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $80 | $80 | $80 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $154 | $154 | $154 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $242 | $242 | $242 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $48 | $48 |
| Special stain group II CPT 88313 • Pathology | $80 | $80 | $80 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $115 | $115 | $115 |
| Frozen section pathology each additional CPT 88332 • Pathology | $80 | $80 | $80 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $59 | $59 | $59 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $55 | $55 | $55 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $80 | $80 | $80 |
| Microdissection manual CPT 88381 • Pathology | $80 | $80 | $80 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $80 | $80 | $80 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $80 | $80 | $80 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $80 | $80 | $80 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $9 | $9 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $80 | $80 | $80 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $24 | $24 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $80 | $80 | $80 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $80 | $80 | $80 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $80 | $80 | $80 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $68 | $68 | $68 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $80 | $80 | $80 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $80 | $80 | $80 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $80 | $80 | $80 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $80 | $80 | $80 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $80 | $80 | $80 |