| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $35 | $67 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $29 | $54 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $53 | $90 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $7 | $37 | $83 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $19 | $50 | $94 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $36 | $81 | $105 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $23 | $350 | $711 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $112 | $475 | $903 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $15 | $128 | $278 |
| Special stain group II CPT 88313 • Pathology | $10 | $84 | $214 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $29 | $109 | $243 |
| Frozen section pathology each additional CPT 88332 • Pathology | $21 | $55 | $96 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $24 | $104 | $239 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $29 | $111 | $278 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $20 | $122 | $293 |
| Microdissection manual CPT 88381 • Pathology | $22 | $198 | $578 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $10 | $19 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $22 | $38 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $11 | $21 | $36 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $25 | $44 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $22 | $44 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $49 | $90 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $53 | $104 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $44 | $90 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $44 | $83 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $32 | $55 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $58 | $157 | $308 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $69 | $155 | $308 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $69 | $159 | $308 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $28 | $93 | $213 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $59 | $113 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $52 | $100 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $56 | $98 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $54 | $103 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $72 | $147 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $65 | $127 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $36 | $63 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $16 | $29 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $34 | $56 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $24 | $40 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $144 | $326 | $398 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $329 | $568 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $98 | $115 | $135 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $24 | $30 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $105 | $127 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $55 | $88 |
| Varicella vaccine CPT 90716 • Preventive Care | $120 | $200 | $237 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $119 | $166 | $294 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $242 | $402 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $92 | $92 | $92 |