| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $181 | $181 | $181 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $546 | $546 | $546 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $226 | $226 | $226 |
| Cytopathology concentration technique CPT 88108 • Pathology | $30 | $30 | $30 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $75 | $75 | $75 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $16 | $16 | $16 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $5 | $5 | $5 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $24 | $24 | $24 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $14 | $14 | $14 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $4 | $4 | $4 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $19 | $19 | $19 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $46 | $46 | $46 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $93 | $93 | $93 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $132 | $132 | $132 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $31 | $31 | $31 |
| Special stain group II CPT 88313 • Pathology | $7 | $19 | $31 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $53 | $53 | $53 |
| Frozen section pathology each additional CPT 88332 • Pathology | $26 | $26 | $26 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $38 | $38 | $38 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $50 | $50 | $50 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $68 | $68 | $68 |
| Microdissection manual CPT 88381 • Pathology | $129 | $129 | $129 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $42 | $42 | $42 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $48 | $48 | $48 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $42 | $42 | $42 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $31 | $31 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $16 | $16 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $31 | $31 | $31 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $16 | $16 | $16 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $114 | $114 | $114 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $70 | $70 | $70 |
| MMR vaccine CPT 90707 • Preventive Care | $48 | $48 | $48 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $85 | $85 | $85 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $53 | $53 | $53 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $141 | $141 | $141 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $147 | $147 | $147 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $154 | $154 | $154 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $174 | $174 | $174 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $169 | $169 | $169 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $195 | $195 | $195 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $212 | $212 | $212 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $127 | $127 | $127 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $136 | $136 | $136 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $135 | $135 | $135 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $148 | $148 | $148 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $152 | $152 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $162 | $162 | $162 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $174 | $174 | $174 |