| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $46 | $83 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $65 | $109 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $17 | $79 | $111 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $37 | $326 | $711 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $147 | $583 | $1,128 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $18 | $120 | $268 |
| Special stain group II CPT 88313 • Pathology | $5 | $86 | $214 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $27 | $133 | $345 |
| Frozen section pathology each additional CPT 88332 • Pathology | $23 | $51 | $97 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $13 | $97 | $334 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $104 | $258 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $30 | $103 | $246 |
| Microdissection manual CPT 88381 • Pathology | $25 | $265 | $578 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $10 | $24 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $19 | $47 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $18 | $44 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $21 | $54 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $20 | $53 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $40 | $73 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $45 | $81 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $40 | $73 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $39 | $68 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $28 | $68 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $58 | $164 | $380 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $156 | $380 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $63 | $169 | $380 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $51 | $113 | $264 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $18 | $48 | $88 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $45 | $81 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $18 | $43 | $77 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $46 | $84 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $26 | $61 | $115 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $52 | $98 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $31 | $87 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $15 | $32 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $29 | $79 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $20 | $56 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $144 | $334 | $557 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $304 | $632 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $109 | $135 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $22 | $30 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $99 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $52 | $98 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $172 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $140 | $327 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $210 | $259 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $89 | $116 | $143 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $74 | $167 | $321 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $78 | $172 | $326 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $81 | $178 | $339 |