| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $34 | $57 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $33 | $50 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $28 | $46 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $24 | $68 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $58 | $124 | $380 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $121 | $380 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $58 | $123 | $380 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $87 | $264 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $40 | $62 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $35 | $55 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $36 | $54 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $34 | $58 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $26 | $50 | $81 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $42 | $71 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $27 | $87 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $12 | $32 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $27 | $79 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $19 | $56 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $144 | $307 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $266 | $310 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $98 | $112 | $135 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $23 | $30 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $100 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $46 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $120 | $189 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $119 | $135 | $160 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $218 | $259 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $89 | $90 | $92 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $57 | $139 | $312 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $70 | $138 | $326 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $63 | $145 | $339 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $74 | $167 | $379 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $83 | $161 | $369 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $86 | $188 | $424 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $95 | $205 | $461 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $64 | $133 | $281 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $55 | $148 | $298 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $59 | $138 | $298 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $63 | $150 | $325 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $65 | $148 | $332 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $70 | $158 | $353 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $88 | $161 | $380 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $47 | $97 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $63 | $152 | $267 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $243 | $385 | $675 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $213 | $366 | $676 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $100 | $241 | $625 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $134 | $245 | $624 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $104 | $185 | $492 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $120 | $385 | $945 |