| Cytogenetics molecular interpretation CPT 88291 • Pathology | $9 | $18 | $25 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $2 | $28 | $60 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $34 | $70 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $23 | $55 | $116 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $22 | $129 | $248 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $39 | $195 | $373 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $7 | $80 | $137 |
| Special stain group II CPT 88313 • Pathology | $3 | $34 | $87 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $25 | $63 | $97 |
| Frozen section pathology each additional CPT 88332 • Pathology | $5 | $29 | $42 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $26 | $53 | $77 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $19 | $66 | $113 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $23 | $68 | $134 |
| Microdissection manual CPT 88381 • Pathology | $44 | $98 | $163 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $5 | $6 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $12 | $16 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $12 | $16 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $14 | $16 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $13 | $16 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $26 | $31 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $28 | $34 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $25 | $33 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $24 | $27 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $16 | $19 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $64 | $185 | $500 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $64 | $87 | $106 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $64 | $79 | $93 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $43 | $53 | $63 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $31 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $28 | $33 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $27 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $29 | $36 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $36 | $51 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $32 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $16 | $30 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $12 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $348 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $252 | $260 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $109 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $23 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $103 | $110 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $48 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $204 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $130 | $147 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $231 | $248 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $75 | $93 | $117 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $79 | $100 | $122 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $93 | $122 | $174 |