| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $3,018 | $3,018 | $3,018 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $74 | $162 | $251 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $48 | $78 | $108 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $232 | $329 | $514 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $189 | $435 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $170 | $297 | $423 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $88 | $239 | $390 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $324 | $324 | $324 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $437 | $737 | $1,038 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $58 | $245 | $435 |
| Cytopathology concentration technique CPT 88108 • Pathology | $4 | $4 | $4 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $106 | $106 | $106 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $20 | $20 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $31 | $31 | $31 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $31 | $31 | $31 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $26 | $28 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $14 | $14 | $14 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $25 | $31 | $38 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $81 | $150 | $219 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $108 | $108 | $108 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $18 | $18 | $18 |
| Special stain group II CPT 88313 • Pathology | $11 | $11 | $11 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $30 | $45 | $59 |
| Frozen section pathology each additional CPT 88332 • Pathology | $30 | $30 | $30 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $61 | $61 | $61 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $38 | $38 | $38 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $92 | $93 | $95 |
| Microdissection manual CPT 88381 • Pathology | $159 | $170 | $181 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $6 | $9 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $20 | $30 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $18 | $26 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $25 | $38 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $18 | $24 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $34 | $58 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $37 | $61 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $37 | $51 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $38 | $55 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $27 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $129 | $182 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $182 | $182 | $182 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $132 | $182 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $79 | $123 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $43 | $73 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $46 | $66 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $36 | $55 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $42 | $57 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $45 | $66 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $47 | $60 |