| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $13 | $20 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $19 | $30 | $41 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $12 | $19 | $33 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $28 | $38 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $7 | $30 | $41 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $14 | $46 | $86 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $21 | $70 | $144 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $69 | $322 | $588 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $141 | $276 | $491 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $29 | $84 | $129 |
| Special stain group II CPT 88313 • Pathology | $29 | $78 | $124 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $65 | $114 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $46 | $82 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $27 | $75 | $181 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $88 | $207 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $34 | $91 | $178 |
| Microdissection manual CPT 88381 • Pathology | $20 | $165 | $261 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $0 | $7 | $16 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $6 | $12 | $18 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $16 | $29 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $15 | $22 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $6 | $13 | $21 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $25 | $33 | $44 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $19 | $34 | $49 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $31 | $44 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $15 | $27 | $34 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $18 | $26 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $71 | $113 | $149 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $70 | $103 | $149 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $71 | $100 | $148 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $45 | $67 | $103 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $16 | $33 | $45 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $18 | $33 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $15 | $33 | $48 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $36 | $51 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $46 | $72 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $39 | $61 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $25 | $28 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $12 | $19 |
| Immunization admin injection single CPT 90471 • Preventive Care | $20 | $21 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $17 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $144 | $404 | $745 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $319 | $573 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $42 | $106 | $135 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $27 | $44 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $123 | $222 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $60 | $88 |
| Varicella vaccine CPT 90716 • Preventive Care | $120 | $235 | $435 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $165 | $296 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $280 | $488 |