| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $162 | $162 | $162 |
| Cytopathology concentration technique CPT 88108 • Pathology | $195 | $195 | $195 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $193 | $193 | $193 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $68 | $68 | $68 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $23 | $23 | $23 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $33 | $33 | $33 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $5 | $5 | $5 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $95 | $95 | $95 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $94 | $94 | $94 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $122 | $122 | $122 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $204 | $204 | $204 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $817 | $817 | $817 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $1,228 | $1,228 | $1,228 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $320 | $320 | $320 |
| Special stain group II CPT 88313 • Pathology | $235 | $235 | $235 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $170 | $170 | $170 |
| Frozen section pathology each additional CPT 88332 • Pathology | $154 | $154 | $154 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $258 | $258 | $258 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $301 | $301 | $301 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $342 | $342 | $342 |
| Microdissection manual CPT 88381 • Pathology | $570 | $570 | $570 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $18 | $18 | $18 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $35 | $35 | $35 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $33 | $33 | $33 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $41 | $41 | $41 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $40 | $40 | $40 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $83 | $83 | $83 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $96 | $96 | $96 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $83 | $83 | $83 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $77 | $77 | $77 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $51 | $51 | $51 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $285 | $285 | $285 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $285 | $285 | $285 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $285 | $285 | $285 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $198 | $198 | $198 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $104 | $104 | $104 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $93 | $93 | $93 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $90 | $90 | $90 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $97 | $97 | $97 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $136 | $136 | $136 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $119 | $119 | $119 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $65 | $65 | $65 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $24 | $24 | $24 |
| Immunization admin injection single CPT 90471 • Preventive Care | $58 | $58 | $58 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $41 | $41 | $41 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $454 | $454 | $454 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $312 | $312 | $312 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $142 | $142 | $142 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $27 | $27 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $131 | $131 | $131 |