| Cytogenetics molecular interpretation CPT 88291 • Pathology | $15 | $29 | $46 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $8 | $42 | $77 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $24 | $52 | $94 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $18 | $71 | $105 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $79 | $296 | $633 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $153 | $429 | $903 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $16 | $111 | $268 |
| Special stain group II CPT 88313 • Pathology | $31 | $87 | $214 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $38 | $85 | $131 |
| Frozen section pathology each additional CPT 88332 • Pathology | $14 | $46 | $75 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $36 | $90 | $187 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $22 | $92 | $206 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $26 | $115 | $246 |
| Microdissection manual CPT 88381 • Pathology | $15 | $207 | $578 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $0 | $9 | $14 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $22 | $30 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $12 | $22 | $28 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $14 | $25 | $35 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $23 | $34 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $24 | $49 | $71 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $26 | $55 | $82 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $21 | $47 | $71 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $23 | $45 | $65 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $25 | $42 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $84 | $150 | $241 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $150 | $241 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $84 | $150 | $241 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $58 | $116 | $165 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $58 | $89 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $54 | $79 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $46 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $40 | $78 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $29 | $59 | $115 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $49 | $98 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $30 | $40 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $21 | $31 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $29 | $40 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $24 | $31 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $349 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $251 | $337 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $111 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $28 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $105 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $58 | $96 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $211 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $130 | $161 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $238 | $248 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $105 | $185 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $160 | $212 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $166 | $221 | $270 |