| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $19 | $34 | $48 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $30 | $42 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $29 | $38 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $19 | $25 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $39 | $95 | $139 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $50 | $97 | $139 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $50 | $97 | $139 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $19 | $63 | $95 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $16 | $36 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $31 | $37 | $46 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $28 | $45 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $29 | $47 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $46 | $69 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $34 | $58 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $13 | $21 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $10 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $19 | $22 | $27 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $13 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $210 | $399 | $651 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $156 | $275 | $364 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $68 | $125 | $203 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $14 | $25 | $39 |
| MMR vaccine CPT 90707 • Preventive Care | $65 | $118 | $194 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $33 | $52 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $125 | $233 | $380 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $142 | $188 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $278 | $426 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $55 | $55 | $55 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $66 | $115 | $153 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $108 | $128 | $160 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $73 | $107 | $166 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $117 | $147 | $187 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $103 | $138 | $181 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $105 | $161 | $210 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $97 | $169 | $228 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $57 | $101 | $138 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $64 | $107 | $147 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $66 | $104 | $147 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $75 | $106 | $160 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $90 | $123 | $164 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $98 | $132 | $174 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $126 | $146 | $187 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $50 | $63 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $51 | $159 | $267 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $243 | $422 | $515 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $142 | $329 | $515 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $130 | $176 | $232 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $187 | $206 | $231 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $64 | $134 | $183 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $215 | $343 | $412 |