| Cytogenetics molecular interpretation CPT 88291 • Pathology | $54 | $54 | $54 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $12 | $12 | $12 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $87 | $87 | $87 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $183 | $183 | $183 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $260 | $260 | $260 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $48 | $48 | $48 |
| Special stain group II CPT 88313 • Pathology | $21 | $21 | $21 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $110 | $110 | $110 |
| Frozen section pathology each additional CPT 88332 • Pathology | $55 | $55 | $55 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $112 | $112 | $112 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $97 | $97 | $97 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $95 | $95 | $95 |
| Microdissection manual CPT 88381 • Pathology | $45 | $45 | $45 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $27 | $27 | $27 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $33 | $33 | $33 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $22 | $22 | $22 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $55 | $55 | $55 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $30 | $30 | $30 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $166 | $166 | $166 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $165 | $165 | $165 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $39 | $39 | $39 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $42 | $42 | $42 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $22 | $22 | $22 |
| Immunization admin injection single CPT 90471 • Preventive Care | $42 | $42 | $42 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $22 | $22 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $327 | $327 | $327 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $105 | $105 |
| MMR vaccine CPT 90707 • Preventive Care | $116 | $116 | $116 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $41 | $41 | $41 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $139 | $139 | $139 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $210 | $210 | $210 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $188 | $188 | $188 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $197 | $197 | $197 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $205 | $205 | $205 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $232 | $232 | $232 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $225 | $225 | $225 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $261 | $261 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $282 | $282 | $282 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $169 | $169 | $169 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $180 | $180 | $180 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $180 | $180 | $180 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $198 | $198 | $198 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $202 | $202 | $202 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $216 | $216 | $216 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $233 | $233 | $233 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $65 | $65 | $65 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $197 | $197 | $197 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $531 | $531 | $531 |