| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $18 | $38 | $59 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $28 | $52 | $76 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $30 | $71 | $107 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $89 | $290 | $511 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $134 | $403 | $762 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $37 | $85 | $165 |
| Special stain group II CPT 88313 • Pathology | $20 | $75 | $133 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $29 | $65 | $87 |
| Frozen section pathology each additional CPT 88332 • Pathology | $19 | $49 | $97 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $34 | $85 | $142 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $104 | $165 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $80 | $149 |
| Microdissection manual CPT 88381 • Pathology | $39 | $146 | $323 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $1 | $6 | $12 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $1 | $15 | $29 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $1 | $14 | $21 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $1 | $17 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $1 | $14 | $25 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $1 | $30 | $52 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $1 | $33 | $58 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $1 | $29 | $52 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $1 | $28 | $49 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $1 | $18 | $32 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $80 | $199 | $500 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $1 | $100 | $177 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $1 | $100 | $177 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $1 | $61 | $123 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $1 | $35 | $63 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $1 | $32 | $58 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $1 | $25 | $56 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $1 | $33 | $60 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $1 | $43 | $84 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $1 | $29 | $74 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $28 | $41 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $14 | $22 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $25 | $37 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $26 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $395 | $521 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $288 | $428 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $125 | $167 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $25 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $119 | $166 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $44 | $55 | $66 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $233 | $310 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $149 | $222 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $267 | $365 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $135 | $192 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $61 | $125 | $201 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $61 | $145 | $208 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $69 | $146 | $234 |