| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $9 | $9 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $7 | $7 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $16 | $16 | $16 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $17 | $17 | $17 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $14 | $14 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $15 | $15 | $15 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $10 | $10 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $48 | $48 | $48 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $48 | $48 | $48 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $33 | $33 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $17 | $17 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $17 | $17 | $17 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $21 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $24 | $24 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $19 | $19 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $17 | $17 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $22 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $11 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $20 | $20 | $20 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $75 | $75 | $75 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $89 | $89 | $89 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $104 | $104 | $104 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $50 | $50 | $50 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $96 | $96 | $96 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $102 | $102 | $102 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $49 | $176 | $303 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $50 | $50 | $50 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $110 | $110 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $137 | $137 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $90 | $90 | $90 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $247 | $247 | $247 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $159 | $159 | $159 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $76 | $76 | $76 |
| Spirometry CPT 94010 • Pulmonology | $40 | $40 | $40 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $17 | $17 | $17 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $40 | $40 | $40 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $45 | $45 | $45 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $35 | $35 | $35 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $37 | $37 | $37 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $18 | $18 | $18 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $178 | $178 | $178 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $52 | $52 | $52 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $145 | $145 | $145 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $21 | $21 | $21 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $926 | $1,062 | $1,198 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $39 | $39 | $39 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $51 | $51 | $51 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $733 | $733 | $734 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $717 | $717 | $717 |