| Sacroiliac joint injection CPT 27096 • Pain Management | $30 | $1,037 | $5,044 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $219 | $409 | $581 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $279 | $463 | $581 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $73 | $340 | $581 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $406 | $1,796 | $5,973 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $41 | $277 | $581 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $26 | $223 | $581 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $231 | $386 | $561 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $30 | $226 | $430 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $279 | $463 | $581 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $75 | $294 | $581 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $75 | $293 | $581 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $437 | $720 | $1,087 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $75 | $369 | $581 |
| Unlisted nervous system procedure CPT 64999 • Pain Management | $75 | $356 | $581 |
| Cytopathology concentration technique CPT 88108 • Pathology | $49 | $110 | $171 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $192 | $192 | $192 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $66 | $66 | $66 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $32 | $52 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $21 | $51 | $80 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $3 | $31 | $58 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $85 | $85 | $85 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $84 | $84 | $84 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $80 | $80 | $80 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $88 | $88 | $88 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $219 | $404 | $589 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $1,128 | $1,128 | $1,128 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $77 | $77 | $77 |
| Special stain group II CPT 88313 • Pathology | $12 | $22 | $31 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $79 | $129 | $178 |
| Frozen section pathology each additional CPT 88332 • Pathology | $88 | $88 | $88 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $68 | $108 | $149 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $50 | $168 | $286 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $60 | $199 | $338 |
| Microdissection manual CPT 88381 • Pathology | $572 | $572 | $572 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $9 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $17 | $24 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $16 | $23 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $22 | $32 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $20 | $28 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $43 | $65 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $44 | $66 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $45 | $65 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $53 | $53 | $53 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $35 | $35 | $35 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $149 | $223 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $153 | $223 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $223 | $223 | $223 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $58 | $106 | $154 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $54 | $82 |