| Special stain group II CPT 88313 • Pathology | $51 | $51 | $51 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $49 | $49 | $49 |
| Frozen section pathology each additional CPT 88332 • Pathology | $39 | $39 | $39 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $68 | $68 | $68 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $80 | $80 | $80 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $98 | $98 | $98 |
| Microdissection manual CPT 88381 • Pathology | $90 | $90 | $90 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $10 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $10 | $10 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $22 | $22 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $19 | $19 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $18 | $18 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $54 | $54 | $54 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $34 | $34 | $34 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $21 | $21 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $21 | $21 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $24 | $24 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $30 | $30 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $26 | $26 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $20 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $16 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $104 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $100 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $133 | $133 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $87 | $106 | $125 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $131 | $131 | $131 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $136 | $136 | $136 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $107 | $112 | $117 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $149 | $149 | $149 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $188 | $188 | $188 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $120 | $120 | $120 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $100 | $100 | $100 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $143 | $143 | $143 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $107 | $107 | $107 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $38 | $38 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $241 | $241 | $241 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $198 | $198 | $198 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $126 | $147 | $168 |