| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $16 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $7 | $10 | $11 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $17 | $23 | $27 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $11 | $16 | $23 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $12 | $18 | $26 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $4 | $20 | $28 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $6 | $26 | $37 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $18 | $51 | $81 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $47 | $139 | $189 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $67 | $149 | $230 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $16 | $45 | $64 |
| Special stain group II CPT 88313 • Pathology | $23 | $36 | $46 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $28 | $45 | $59 |
| Frozen section pathology each additional CPT 88332 • Pathology | $17 | $21 | $24 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $25 | $44 | $59 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $20 | $49 | $68 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $22 | $47 | $74 |
| Microdissection manual CPT 88381 • Pathology | $84 | $92 | $99 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $6 | $6 | $6 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $11 | $11 | $11 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $18 | $18 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $60 | $60 | $60 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $66 | $66 | $66 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $21 | $21 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $21 | $21 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $31 | $31 | $31 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $33 | $33 | $33 |
| Immunization admin injection single CPT 90471 • Preventive Care | $33 | $33 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $101 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $40 | $40 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $146 | $146 | $146 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $177 | $177 | $177 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $47 | $55 | $63 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $77 | $77 | $77 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $298 | $298 | $298 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $138 | $138 | $138 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $355 | $355 | $355 |
| Spirometry CPT 94010 • Pulmonology | $51 | $51 | $51 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $75 | $75 | $75 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $60 | $60 | $60 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $38 | $38 | $38 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $307 | $307 | $307 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $2,033 | $2,033 | $2,033 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $88 | $88 | $88 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $1,281 | $1,281 | $1,281 |
| Proton beam treatment simple CPT 77520 • Radiation Therapy | $957 | $957 | $957 |
| Polysomnography under age 6 with CPAP CPT 95783 • Sleep Medicine | $1,080 | $1,080 | $1,080 |
| Multiple sleep latency test (MSLT) CPT 95805 • Sleep Medicine | $554 | $554 | $554 |