| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $27 | $43 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $27 | $40 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $18 | $26 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $69 | $94 | $146 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $69 | $98 | $146 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $69 | $98 | $146 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $60 | $89 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $33 | $52 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $31 | $48 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $30 | $46 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $31 | $50 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $39 | $69 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $35 | $61 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $18 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $19 | $30 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $11 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $326 | $409 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $159 | $238 | $284 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $104 | $128 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $99 | $118 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $45 | $61 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $192 | $239 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $131 | $147 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $230 | $268 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $92 | $92 | $92 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $78 | $112 | $185 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $109 | $125 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $75 | $125 | $194 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $85 | $138 | $192 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $100 | $142 | $211 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $105 | $151 | $243 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $115 | $175 | $265 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $94 | $160 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $78 | $98 | $114 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $92 | $114 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $75 | $119 | $186 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $89 | $115 | $169 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $100 | $132 | $179 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $112 | $143 | $193 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $22 | $37 | $56 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $97 | $169 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $232 | $343 | $489 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $197 | $347 | $489 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $155 | $238 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $191 | $238 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $130 | $188 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $158 | $255 | $428 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $190 | $294 | $396 |