| Immunohistochemistry first antibody CPT 88342 • Pathology | $77 | $110 | $143 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $76 | $126 | $177 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $17 | $17 | $17 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $42 | $42 | $42 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $46 | $46 | $46 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $40 | $40 | $40 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $155 | $155 | $155 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $156 | $156 | $156 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $54 | $54 | $54 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $33 | $33 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $13 | $13 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $29 | $29 | $29 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $20 | $20 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $209 | $209 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $56 | $56 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $152 | $152 | $152 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $165 | $165 | $165 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $181 | $181 | $181 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $195 | $195 | $195 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $156 | $156 | $156 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $145 | $145 | $145 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $179 | $179 | $179 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $173 | $173 | $173 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $190 | $190 | $190 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $169 | $169 | $169 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $199 | $199 | $199 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $199 | $199 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $202 | $202 | $202 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $265 | $265 | $265 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $332 | $332 | $332 |
| Spirometry CPT 94010 • Pulmonology | $46 | $46 | $46 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $16 | $16 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $99 | $99 | $99 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $13 | $13 | $13 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $3 | $3 | $3 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $485 | $485 | $485 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $95 | $95 | $95 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $1,216 | $1,216 | $1,216 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $174 | $174 | $174 |
| Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy | $539 | $539 | $539 |
| Polysomnography age 6 or older CPT 95810 • Sleep Medicine | $191 | $191 | $191 |
| Polysomnography with CPAP titration CPT 95811 • Sleep Medicine | $188 | $188 | $188 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $875 | $875 | $875 |
| Complex uroflowmetry CPT 51741 • Urology | $24 | $24 | $24 |
| Post-void residual urine measurement CPT 51798 • Urology | $16 | $16 | $16 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $334 | $334 | $334 |
| Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology | $292 | $292 | $292 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $329 | $329 | $329 |
| TURP transurethral resection of prostate CPT 52601 • Urology | $1,110 | $1,110 | $1,110 |
| Circumcision CPT 54150 • Urology | $133 | $133 | $133 |