| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $15 | $35 | $52 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $27 | $40 | $54 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $6 | $30 | $71 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $11 | $34 | $66 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $52 | $103 | $272 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $225 | $297 | $427 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $141 | $375 | $649 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $65 | $115 | $157 |
| Special stain group II CPT 88313 • Pathology | $22 | $77 | $114 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $38 | $98 | $158 |
| Frozen section pathology each additional CPT 88332 • Pathology | $25 | $50 | $86 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $11 | $81 | $150 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $27 | $81 | $176 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $34 | $112 | $216 |
| Microdissection manual CPT 88381 • Pathology | $23 | $186 | $278 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $8 | $9 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $12 | $19 | $25 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $17 | $26 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $13 | $18 | $22 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $12 | $16 | $20 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $25 | $32 | $42 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $38 | $49 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $25 | $35 | $42 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $23 | $34 | $44 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $16 | $22 | $26 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $60 | $98 | $139 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $98 | $139 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $58 | $99 | $139 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $30 | $61 | $95 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $39 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $37 | $48 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $34 | $47 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $30 | $41 | $53 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $47 | $69 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $31 | $46 | $58 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $21 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $11 | $18 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $14 | $23 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $7 | $12 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $341 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $262 | $283 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $110 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $23 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $105 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $47 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $208 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $119 | $131 | $149 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $227 | $248 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $57 | $118 | $155 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $70 | $129 | $170 |