| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $45 | $66 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $15 | $32 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $42 | $72 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $31 | $58 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $62 | $90 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $15 | $51 | $95 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $11 | $48 | $114 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $39 | $121 | $277 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $133 | $333 | $787 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $64 | $614 | $1,193 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $29 | $128 | $311 |
| Special stain group II CPT 88313 • Pathology | $17 | $103 | $224 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $114 | $277 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $55 | $147 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $102 | $242 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $42 | $110 | $277 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $55 | $179 | $334 |
| Microdissection manual CPT 88381 • Pathology | $60 | $196 | $434 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $0 | $5 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $16 | $30 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $6 | $13 | $28 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $7 | $14 | $34 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $14 | $33 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $37 | $69 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $41 | $80 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $29 | $69 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $16 | $30 | $63 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $17 | $41 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $68 | $203 | $500 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $66 | $132 | $271 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $68 | $136 | $271 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $62 | $162 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $44 | $87 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $43 | $77 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $43 | $77 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $14 | $41 | $78 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $29 | $56 | $114 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $47 | $97 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $29 | $39 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $16 | $29 |
| Immunization admin injection single CPT 90471 • Preventive Care | $19 | $28 | $39 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $20 | $30 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $225 | $425 | $997 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $198 | $326 | $766 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $91 | $136 | $311 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $27 | $59 |
| MMR vaccine CPT 90707 • Preventive Care | $78 | $127 | $297 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $59 | $118 |
| Varicella vaccine CPT 90716 • Preventive Care | $134 | $241 | $582 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $104 | $164 | $396 |