| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $16 | $28 | $44 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $14 | $38 | $59 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $6 | $28 | $56 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $10 | $45 | $71 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $50 | $78 | $122 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $23 | $315 | $480 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $149 | $393 | $718 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $24 | $101 | $186 |
| Special stain group II CPT 88313 • Pathology | $5 | $77 | $136 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $16 | $81 | $172 |
| Frozen section pathology each additional CPT 88332 • Pathology | $13 | $54 | $93 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $23 | $77 | $161 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $30 | $92 | $188 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $36 | $114 | $200 |
| Microdissection manual CPT 88381 • Pathology | $65 | $218 | $322 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $10 | $16 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $20 | $42 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $12 | $17 | $21 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $24 | $50 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $20 | $28 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $40 | $51 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $25 | $45 | $57 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $22 | $41 | $61 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $37 | $48 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $15 | $27 | $45 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $77 | $136 | $175 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $77 | $136 | $175 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $82 | $137 | $175 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $53 | $84 | $103 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $46 | $61 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $28 | $47 | $69 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $48 | $81 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $26 | $47 | $86 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $66 | $95 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $59 | $87 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $19 | $28 | $39 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $13 | $19 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $26 | $35 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $436 | $716 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $311 | $480 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $113 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $25 | $39 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $134 | $214 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $49 | $57 | $74 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $212 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $119 | $162 | $248 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $289 | $469 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $59 | $133 | $189 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $62 | $140 | $198 |