| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $3 | $29 | $74 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $34 | $95 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $32 | $53 | $80 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $91 | $262 | $638 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $64 | $367 | $952 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $13 | $64 | $118 |
| Special stain group II CPT 88313 • Pathology | $3 | $36 | $95 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $16 | $75 | $152 |
| Frozen section pathology each additional CPT 88332 • Pathology | $5 | $37 | $84 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $11 | $57 | $140 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $16 | $57 | $97 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $27 | $96 | $189 |
| Microdissection manual CPT 88381 • Pathology | $49 | $148 | $312 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $4 | $9 | $15 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $19 | $28 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $12 | $19 | $26 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $30 | $77 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $18 | $31 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $38 | $65 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $46 | $72 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $38 | $65 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $35 | $61 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $24 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $58 | $126 | $221 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $126 | $221 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $130 | $221 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $28 | $76 | $153 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $50 | $79 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $47 | $73 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $48 | $77 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $45 | $76 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $26 | $62 | $105 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $56 | $92 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $15 | $27 | $51 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $11 | $19 |
| Immunization admin injection single CPT 90471 • Preventive Care | $8 | $23 | $46 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $32 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $285 | $328 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $282 | $364 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $42 | $95 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $25 | $37 |
| MMR vaccine CPT 90707 • Preventive Care | $35 | $89 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $44 | $51 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $50 | $172 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $25 | $109 | $147 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $195 | $221 | $248 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $55 | $128 | $240 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $55 | $128 | $251 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $60 | $127 | $260 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $70 | $150 | $292 |