| Cytopathology cell enhancement technique CPT 88112 • Pathology | $106 | $106 | $106 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $20 | $20 | $20 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $9 | $9 | $9 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $31 | $31 | $31 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $31 | $31 | $31 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $26 | $28 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $14 | $14 | $14 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $22 | $22 | $22 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $29 | $33 | $38 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $81 | $150 | $219 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $108 | $108 | $108 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $18 | $18 | $18 |
| Special stain group II CPT 88313 • Pathology | $11 | $11 | $11 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $59 | $69 | $79 |
| Frozen section pathology each additional CPT 88332 • Pathology | $30 | $30 | $30 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $61 | $61 | $61 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $38 | $38 | $38 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $32 | $63 | $95 |
| Microdissection manual CPT 88381 • Pathology | $159 | $170 | $181 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $6 | $9 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $20 | $30 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $18 | $26 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $25 | $38 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $18 | $24 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $34 | $58 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $37 | $61 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $37 | $51 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $38 | $55 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $27 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $129 | $182 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $182 | $182 | $182 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $182 | $182 | $182 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $58 | $90 | $123 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $43 | $73 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $46 | $66 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $36 | $55 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $42 | $57 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $45 | $66 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $47 | $60 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $24 | $54 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $14 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $8 | $12 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $12 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $355 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $264 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $111 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $104 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $50 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $207 | $230 |