| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $33 | $39 | $50 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $86 | $191 | $288 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $135 | $169 | $195 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $25 | $46 | $77 |
| Special stain group II CPT 88313 • Pathology | $11 | $35 | $61 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $31 | $54 | $72 |
| Frozen section pathology each additional CPT 88332 • Pathology | $16 | $28 | $38 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $14 | $56 | $94 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $49 | $77 | $113 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $37 | $85 | $134 |
| Microdissection manual CPT 88381 • Pathology | $13 | $54 | $95 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $6 | $8 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $14 | $19 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $12 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $15 | $20 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $15 | $20 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $27 | $42 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $31 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $31 | $41 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $28 | $38 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $19 | $25 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $69 | $85 | $116 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $69 | $93 | $116 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $69 | $93 | $116 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $48 | $63 | $79 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $39 | $53 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $34 | $46 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $45 | $45 | $45 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $31 | $47 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $49 | $66 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $33 | $44 | $56 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $39 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $16 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $362 | $370 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $249 | $251 | $254 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $95 | $108 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $25 | $32 |
| MMR vaccine CPT 90707 • Preventive Care | $99 | $105 | $108 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $43 | $57 | $73 |
| Varicella vaccine CPT 90716 • Preventive Care | $212 | $215 | $218 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $131 | $138 | $144 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $237 | $295 | $405 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $89 | $118 | $149 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $93 | $124 | $156 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $97 | $115 | $127 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $110 | $132 | $143 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $107 | $119 | $137 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $124 | $159 | $208 |