| Cytogenetics molecular interpretation CPT 88291 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $25 | $25 | $25 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $219 | $219 | $219 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $92 | $92 | $92 |
| Microdissection manual CPT 88381 • Pathology | $159 | $159 | $159 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $10 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $9 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $12 | $12 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $24 | $24 | $24 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $28 | $28 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $24 | $24 | $24 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $22 | $22 | $22 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $57 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $30 | $30 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $27 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $27 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $34 | $34 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $257 | $257 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $187 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $106 | $106 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $115 | $131 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $67 | $67 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $122 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $132 | $132 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $214 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $127 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $243 | $243 | $243 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $252 | $252 | $252 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $91 | $91 |
| Spirometry CPT 94010 • Pulmonology | $26 | $26 | $26 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $30 | $30 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $30 | $30 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $52 | $52 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $42 | $42 | $42 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $55 | $55 | $55 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $25 | $25 | $25 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $257 | $257 | $257 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $81 | $81 | $81 |