| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $101 | $140 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $115 | $160 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $17 | $17 | $17 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $13 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $16 | $19 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $19 | $19 | $19 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $40 | $40 | $40 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $46 | $46 | $46 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $40 | $40 | $40 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $37 | $37 | $37 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $24 | $24 | $24 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $136 | $136 | $136 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $136 | $136 | $136 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $105 | $126 | $136 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $94 | $94 | $94 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $40 | $49 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $44 | $44 | $44 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $43 | $43 | $43 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $28 | $28 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $64 | $64 | $64 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $21 | $27 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $8 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $19 | $25 | $27 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $20 | $20 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $316 | $316 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $99 | $99 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $16 | $20 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $91 | $91 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $47 | $54 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $184 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $99 | $140 | $188 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $200 | $200 | $200 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $122 | $122 | $122 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $109 | $109 | $109 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $114 | $114 | $114 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $120 | $120 | $120 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $162 | $162 | $162 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $175 | $175 | $175 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $122 | $122 | $122 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $100 | $100 | $100 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $140 | $140 | $140 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $138 | $138 | $138 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $131 | $131 | $131 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $143 | $143 | $143 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $109 | $109 | $109 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $43 | $43 | $43 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $217 | $217 | $217 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $223 | $223 | $223 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $223 | $223 | $223 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $117 | $156 | $175 |