| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $11 | $34 | $63 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $15 | $48 | $92 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $40 | $74 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $36 | $65 | $108 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $58 | $98 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $71 | $107 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $32 | $111 | $220 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $66 | $474 | $890 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $113 | $784 | $1,354 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $38 | $208 | $347 |
| Special stain group II CPT 88313 • Pathology | $3 | $147 | $251 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $16 | $162 | $322 |
| Frozen section pathology each additional CPT 88332 • Pathology | $8 | $80 | $170 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $11 | $164 | $290 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $12 | $189 | $326 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $31 | $209 | $385 |
| Microdissection manual CPT 88381 • Pathology | $39 | $372 | $631 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $9 | $16 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $8 | $19 | $34 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $20 | $34 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $18 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $20 | $34 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $39 | $67 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $47 | $79 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $17 | $38 | $67 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $39 | $62 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $23 | $41 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $65 | $134 | $230 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $132 | $230 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $65 | $135 | $230 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $45 | $91 | $160 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $18 | $47 | $87 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $43 | $76 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $39 | $74 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $44 | $78 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $20 | $60 | $115 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $51 | $98 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $27 | $53 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $13 | $30 |
| Immunization admin injection single CPT 90471 • Preventive Care | $19 | $31 | $53 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $20 | $30 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $161 | $405 | $785 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $318 | $552 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $126 | $245 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $33 | $93 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $127 | $234 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $56 | $85 |
| Varicella vaccine CPT 90716 • Preventive Care | $90 | $220 | $458 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $92 | $160 | $286 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $275 | $514 |