| Peripheral nerve block injection CPT 64450 • Pain Management | $75 | $140 | $205 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $50 | $84 | $137 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $288 | $417 | $672 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $137 | $221 | $306 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $187 | $301 | $482 |
| Facet joint injection lumbar second level CPT 64494 • Pain Management | $93 | $154 | $248 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $125 | $247 | $418 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $235 | $535 | $1,207 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $62 | $244 | $658 |
| Cytopathology concentration technique CPT 88108 • Pathology | $64 | $64 | $64 |
| 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 | $52 | $52 | $52 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $58 | $69 | $80 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $64 | $64 | $64 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $94 | $94 | $94 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $73 | $73 | $73 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $35 | $78 | $121 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $205 | $205 | $205 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $237 | $237 | $237 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $833 | $833 | $833 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $320 | $320 | $320 |
| Special stain group II CPT 88313 • Pathology | $232 | $232 | $232 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $178 | $178 | $178 |
| Frozen section pathology each additional CPT 88332 • Pathology | $88 | $88 | $88 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $53 | $150 | $247 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $98 | $99 | $100 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $41 | $129 | $218 |
| Microdissection manual CPT 88381 • Pathology | $572 | $572 | $572 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $12 | $12 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $19 | $22 | $24 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $23 | $23 | $23 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $18 | $23 | $28 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $17 | $23 | $28 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $37 | $47 | $57 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $47 | $57 | $66 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $37 | $47 | $57 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $34 | $44 | $53 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $35 | $35 | $35 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $117 | $156 | $196 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $115 | $155 | $196 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $117 | $156 | $196 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $79 | $107 | $135 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $54 | $63 | $72 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $47 | $55 | $64 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $62 | $62 | $62 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $48 | $57 | $66 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $93 | $93 | $93 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $81 | $81 | $81 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $23 | $51 |