| Immunohistochemistry each antibody CPT 88341 • Pathology | $31 | $31 | $31 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $26 | $26 | $26 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $30 | $30 |
| Microdissection manual CPT 88381 • Pathology | $26 | $26 | $26 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $2 | $2 | $2 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $6 | $6 | $6 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $7 | $7 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $8 | $8 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $5 | $5 | $5 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $13 | $13 | $13 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $14 | $14 | $14 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $12 | $12 | $12 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $12 | $12 | $12 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $8 | $8 | $8 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $38 | $38 | $38 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $38 | $38 | $38 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $38 | $38 | $38 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $26 | $26 | $26 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $14 | $14 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $14 | $14 | $14 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $13 | $13 | $13 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $14 | $14 | $14 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $15 | $15 | $15 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $13 | $13 | $13 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $11 | $11 | $11 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $6 | $6 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $5 | $5 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $148 | $148 | $148 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $116 | $116 | $116 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $46 | $46 | $46 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $10 | $10 |
| MMR vaccine CPT 90707 • Preventive Care | $44 | $44 | $44 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $22 | $22 | $22 |
| Varicella vaccine CPT 90716 • Preventive Care | $86 | $86 | $86 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $53 | $53 | $53 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $97 | $97 | $97 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $28 | $28 | $28 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $32 | $32 | $32 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $45 | $45 | $45 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $36 | $36 | $36 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $36 | $36 | $36 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $44 | $44 | $44 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $63 | $63 | $63 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $35 | $35 | $35 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $39 | $39 | $39 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $39 | $39 | $39 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $43 | $43 | $43 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $43 | $43 | $43 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $47 | $47 | $47 |