| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $206 | $285 | $420 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $1,700 | $1,700 | $1,700 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $30 | $101 | $173 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $67 | $82 | $110 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $326 | $430 | $534 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $70 | $90 | $110 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $235 | $313 | $392 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $83 | $135 | $201 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $150 | $208 | $274 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $384 | $635 | $938 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $82 | $173 | $226 |
| Cytopathology concentration technique CPT 88108 • Pathology | $44 | $70 | $97 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $81 | $85 | $90 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $17 | $29 | $41 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $15 | $22 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $38 | $43 | $55 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $17 | $33 | $49 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $18 | $48 | $77 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $29 | $52 | $75 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $57 | $61 | $65 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $52 | $58 | $64 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $45 | $283 | $425 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $197 | $198 | $199 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $37 | $49 | $60 |
| Special stain group II CPT 88313 • Pathology | $44 | $60 | $72 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $38 | $45 |
| Frozen section pathology each additional CPT 88332 • Pathology | $24 | $41 | $57 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $42 | $65 | $88 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $61 | $72 | $83 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $93 | $93 | $94 |
| Microdissection manual CPT 88381 • Pathology | $59 | $89 | $119 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $14 | $56 | $77 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $34 | $77 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $16 | $37 | $77 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $35 | $77 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $41 | $77 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $25 | $53 | $77 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $38 | $59 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $69 | $74 | $77 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $24 | $47 | $66 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $36 | $57 | $77 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $77 | $136 | $195 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $48 | $91 | $144 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $77 | $110 | $144 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $48 | $91 | $134 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $60 | $90 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $77 | $77 | $78 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $38 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $52 | $79 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $50 | $67 |