| Immunohistochemistry first antibody CPT 88342 • Pathology | $97 | $128 | $159 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $58 | $123 | $189 |
| Microdissection manual CPT 88381 • Pathology | $6 | $6 | $6 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $9 | $9 | $9 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $15 | $16 | $18 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $17 | $17 | $17 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $20 | $20 | $20 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $13 | $17 | $21 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $33 | $37 | $42 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $38 | $43 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $32 | $37 | $42 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $25 | $32 | $39 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $25 | $25 | $25 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $3 | $48 | $92 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $3 | $48 | $92 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $3 | $3 | $3 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $63 | $82 | $100 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $42 | $48 | $53 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $47 | $50 | $53 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $46 | $46 | $46 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $49 | $51 | $54 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $70 | $70 | $70 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $60 | $60 | $60 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $1 | $11 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $0 | $10 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $1 | $11 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $0 | $7 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $302 | $302 | $302 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $8 | $119 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $112 | $112 | $112 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $104 | $104 | $104 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $1 | $18 | $34 |
| Varicella vaccine CPT 90716 • Preventive Care | $180 | $180 | $180 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $4 | $62 | $120 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $201 | $201 | $201 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $71 | $71 | $71 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $3 | $71 | $139 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $4 | $74 | $145 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $4 | $77 | $151 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $4 | $87 | $171 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $4 | $85 | $165 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $5 | $98 | $192 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $5 | $106 | $208 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $93 | $109 | $125 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $3 | $50 | $97 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $3 | $68 | $133 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $4 | $74 | $145 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $4 | $100 | $197 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $4 | $100 | $197 |