| Cytogenetics molecular interpretation CPT 88291 • Pathology | $12 | $21 | $26 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $5 | $17 | $28 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $23 | $29 | $37 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $18 | $37 | $81 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $51 | $115 | $189 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $70 | $170 | $230 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $17 | $46 | $81 |
| Special stain group II CPT 88313 • Pathology | $24 | $42 | $60 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $28 | $41 | $51 |
| Frozen section pathology each additional CPT 88332 • Pathology | $18 | $27 | $39 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $19 | $41 | $57 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $20 | $57 | $76 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $27 | $52 | $74 |
| Microdissection manual CPT 88381 • Pathology | $92 | $107 | $129 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $9 | $9 | $9 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $8 | $8 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $11 | $11 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $10 | $10 | $10 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $21 | $21 | $21 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $20 | $22 | $24 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $21 | $21 | $21 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $13 | $13 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $72 | $72 | $72 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $60 | $66 | $72 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $72 | $72 | $72 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $50 | $50 | $50 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $23 | $26 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $22 | $24 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $23 | $23 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $25 | $25 | $25 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $34 | $34 | $34 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $30 | $30 | $30 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $17 | $17 | $17 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $6 | $6 |
| Immunization admin injection single CPT 90471 • Preventive Care | $15 | $15 | $15 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $11 | $11 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $100 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $40 | $40 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $79 | $79 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $82 | $82 | $82 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $59 | $59 | $59 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $70 | $70 | $70 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $67 | $67 | $67 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $107 | $107 | $107 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $87 | $87 | $87 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $48 | $48 | $48 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $75 | $75 | $75 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $75 | $75 | $75 |