| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $13 | $39 | $121 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $6 | $13 | $18 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $33 | $68 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $13 | $25 | $37 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $16 | $27 | $35 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $8 | $39 | $79 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $19 | $52 | $102 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $55 | $747 | $4,688 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $104 | $205 | $323 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $33 | $263 | $486 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $16 | $364 | $2,085 |
| Special stain group II CPT 88313 • Pathology | $5 | $2,332 | $16,081 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $40 | $322 | $1,724 |
| Frozen section pathology each additional CPT 88332 • Pathology | $23 | $40 | $56 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $1,170 | $7,726 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $30 | $73 | $117 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $118 | $453 |
| Microdissection manual CPT 88381 • Pathology | $52 | $112 | $204 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $4 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $13 | $18 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $14 | $24 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $14 | $18 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $42 | $223 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $32 | $46 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $58 | $195 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $65 | $248 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $29 | $44 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $22 | $29 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $71 | $113 | $270 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $71 | $145 | $492 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $57 | $79 | $103 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $28 | $55 | $73 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $18 | $32 | $47 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $35 | $53 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $26 | $32 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $37 | $54 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $43 | $61 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $33 | $52 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $22 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $12 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $153 | $935 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $14 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $302 | $347 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $275 | $353 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $80 | $355 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $107 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $139 | $665 |
| Varicella vaccine CPT 90716 • Preventive Care | $180 | $204 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $141 | $185 |