| Sacroiliac joint injection CPT 27096 • Pain Management | $42 | $1,131 | $4,717 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $351 | $537 | $623 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $346 | $531 | $623 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $10 | $415 | $623 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $30 | $2,126 | $7,197 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $31 | $287 | $623 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $25 | $400 | $623 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $232 | $540 | $677 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $103 | $403 | $623 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $175 | $465 | $677 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $38 | $290 | $623 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $97 | $434 | $623 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $623 | $787 | $1,309 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $429 | $575 | $623 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $42 | $401 | $623 |
| Cytopathology concentration technique CPT 88108 • Pathology | $49 | $58 | $67 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $13 | $34 | $55 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $28 | $28 | $28 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $14 | $15 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $42 | $63 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $9 | $11 | $12 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $17 | $17 | $17 |
| 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 | $5 | $24 | $41 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $17 | $65 | $100 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $156 | $351 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $336 | $336 | $336 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $56 | $77 | $120 |
| Special stain group II CPT 88313 • Pathology | $5 | $32 | $42 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $40 | $48 |
| Frozen section pathology each additional CPT 88332 • Pathology | $29 | $29 | $29 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $40 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $61 | $100 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $38 | $68 | $78 |
| Microdissection manual CPT 88381 • Pathology | $80 | $80 | $80 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $12 | $14 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $12 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $13 | $15 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $11 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $24 | $29 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $26 | $30 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $23 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $21 | $23 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $18 | $18 | $18 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $81 | $124 | $166 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $80 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $64 | $70 | $75 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $55 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $27 | $27 |