| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $74 | $102 |
| Special stain group II CPT 88313 • Pathology | $17 | $55 | $73 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $37 | $63 | $94 |
| Frozen section pathology each additional CPT 88332 • Pathology | $11 | $37 | $50 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $45 | $69 | $80 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $37 | $74 | $92 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $37 | $86 | $110 |
| Microdissection manual CPT 88381 • Pathology | $106 | $106 | $106 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $15 | $15 | $15 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $14 | $14 | $14 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $29 | $29 | $29 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $34 | $34 | $34 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $29 | $29 | $29 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $27 | $27 | $27 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $18 | $18 | $18 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $100 | $100 | $100 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $100 | $100 | $100 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $100 | $100 | $100 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $69 | $69 | $69 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $37 | $37 | $37 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $33 | $33 | $33 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $48 | $48 | $48 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $12 | $12 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $45 | $45 | $45 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $154 | $156 | $157 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $161 | $163 | $165 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $168 | $170 | $172 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $148 | $177 | $193 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $183 | $186 | $187 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $213 | $216 | $218 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $230 | $234 | $236 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $138 | $140 | $141 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $111 | $136 | $151 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $147 | $149 | $150 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $125 | $151 | $165 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $165 | $168 | $169 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $176 | $179 | $180 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $189 | $192 | $194 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $6,072 | $6,162 | $6,252 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $402 | $3,282 | $6,252 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $107 | $3,209 | $6,252 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $194 | $194 | $194 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $152 | $152 | $152 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $361 | $3,055 | $7,189 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $406 | $3,082 | $7,189 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $216 | $3,031 | $7,189 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $497 | $3,138 | $7,189 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $528 | $3,157 | $7,189 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,227 | $6,981 | $15,806 |