| Immunohistochemistry first antibody CPT 88342 • Pathology | $60 | $68 | $77 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $23 | $47 | $71 |
| Microdissection manual CPT 88381 • Pathology | $159 | $159 | $159 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $4 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $9 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $7 | $7 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $8 | $9 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $9 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $18 | $18 | $18 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $28 | $28 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $21 | $24 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $22 | $22 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $10 | $10 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $61 | $61 | $61 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $43 | $43 | $43 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $23 | $23 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $27 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $19 | $20 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $27 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $30 | $34 |
| 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 | $5 | $8 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $5 | $5 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $274 | $274 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $271 | $271 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $18 | $18 | $18 |
| MMR vaccine CPT 90707 • Preventive Care | $117 | $117 | $117 |
| Varicella vaccine CPT 90716 • Preventive Care | $46 | $46 | $46 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $70 | $70 | $70 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $56 | $56 | $56 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $95 | $95 | $95 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $99 | $99 | $99 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $112 | $112 | $112 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $125 | $125 | $125 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $67 | $67 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $87 | $95 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $87 | $87 | $87 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $89 | $95 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $97 | $97 | $97 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $104 | $104 | $104 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $112 | $112 | $112 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $26 | $26 | $26 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $92 | $131 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $207 | $233 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $109 | $109 | $110 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $109 | $109 | $110 |