| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $0 | $47 | $100 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $5 | $9 | $12 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $5 | $21 | $36 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $5 | $15 | $21 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $0 | $40 | $131 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $0 | $54 | $117 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $0 | $38 | $69 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $0 | $59 | $116 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $1 | $261 | $469 |
| Surgical pathology gross and micro exam level VI CPT 88309 • Pathology | $4 | $734 | $1,616 |
| Special stain group I for microorganisms CPT 88312 • Pathology | $0 | $83 | $182 |
| Special stain group II CPT 88313 • Pathology | $1 | $123 | $289 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $1 | $111 | $382 |
| Frozen section pathology each additional CPT 88332 • Pathology | $0 | $92 | $211 |
| Immunohistochemistry each antibody CPT 88341 • Pathology | $1 | $74 | $140 |
| Immunohistochemistry first antibody CPT 88342 • Pathology | $1 | $78 | $162 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $0 | $147 | $482 |
| Microdissection manual CPT 88381 • Pathology | $2 | $70 | $131 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $0 | $7 | $17 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $6 | $15 | $39 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $8 | $16 | $34 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $17 | $41 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $22 | $39 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $17 | $45 | $84 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $18 | $39 | $97 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $15 | $31 | $83 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $16 | $33 | $77 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $9 | $28 | $50 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $66 | $146 | $234 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $66 | $112 | $234 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $66 | $105 | $234 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $37 | $47 | $54 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $45 | $108 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $18 | $51 | $93 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $50 | $91 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $17 | $53 | $95 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $20 | $47 | $135 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $63 | $115 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $29 | $75 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $33 | $67 |
| Immunization admin injection single CPT 90471 • Preventive Care | $15 | $34 | $75 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $34 | $67 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $336 | $369 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $486 | $842 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $108 | $116 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $43 | $72 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $104 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $81 | $125 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $197 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $208 | $439 |