| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $95 | $95 | $96 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $79 | $79 | $79 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $133 | $133 | $133 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $379 | $379 | $379 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $203 | $203 | $204 |
| Cytopathology concentration technique CPT 88108 • Pathology | $45 | $45 | $45 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $12 | $12 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $18 | $18 | $18 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $45 | $45 | $45 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $182 | $182 | $182 |
| Special stain group II CPT 88313 • Pathology | $52 | $52 | $52 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $38 | $51 | $64 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $61 | $61 | $61 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $72 | $72 | $72 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $50 | $63 | $76 |
| Microdissection manual CPT 88381 • Pathology | $123 | $123 | $123 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $3 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $6 | $6 | $7 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $10 | $10 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $7 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $18 | $18 | $18 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $26 | $26 | $26 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $23 | $23 | $24 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $17 | $17 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $81 | $81 | $81 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $81 | $81 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $56 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $28 | $28 | $28 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $26 | $26 | $26 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $25 | $25 | $25 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $27 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $37 | $37 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $33 | $33 | $33 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $5 | $5 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $10 | $10 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $21 | $21 |
| Varicella vaccine CPT 90716 • Preventive Care | $39 | $39 | $39 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $20 | $20 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $36 | $36 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $80 | $80 | $80 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $84 | $84 | $84 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $87 | $87 | $87 |