| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $27 | $42 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $13 | $20 | $33 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $48 | $82 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $32 | $46 | $66 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $21 | $41 | $68 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $8 | $34 | $50 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $13 | $34 | $67 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $37 | $71 | $115 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $107 | $224 | $449 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $143 | $328 | $684 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $28 | $79 | $171 |
| Special stain group II CPT 88313 • Pathology | $3 | $59 | $123 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $16 | $69 | $163 |
| Frozen section pathology each additional CPT 88332 • Pathology | $10 | $41 | $90 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $66 | $150 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $30 | $72 | $171 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $41 | $107 | $204 |
| Microdissection manual CPT 88381 • Pathology | $65 | $213 | $385 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $9 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $16 | $24 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $22 | $43 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $23 | $42 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $15 | $24 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $30 | $51 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $36 | $59 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $36 | $63 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $31 | $47 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $17 | $25 | $31 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $58 | $96 | $143 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $96 | $143 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $117 | $189 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $28 | $62 | $98 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $49 | $65 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $37 | $57 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $39 | $68 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $36 | $58 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $56 | $85 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $40 | $74 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $16 | $26 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $16 | $30 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $9 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $330 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $250 | $260 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $107 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $24 | $28 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $102 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $47 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $198 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $146 | $170 |