| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $48 | $74 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $17 | $41 | $63 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $40 | $67 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $26 | $39 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $58 | $117 | $180 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $120 | $180 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $58 | $123 | $180 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $94 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $18 | $51 | $77 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $24 | $51 | $77 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $50 | $68 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $46 | $74 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $54 | $85 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $50 | $74 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $33 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $17 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $31 | $59 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $18 | $27 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $302 | $422 | $668 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $315 | $560 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $98 | $132 | $214 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $32 | $49 |
| MMR vaccine CPT 90707 • Preventive Care | $65 | $123 | $207 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $73 | $106 |
| Varicella vaccine CPT 90716 • Preventive Care | $114 | $234 | $397 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $60 | $155 | $254 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $179 | $278 | $468 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $77 | $77 | $77 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $75 | $139 | $258 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $85 | $149 | $225 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $89 | $151 | $235 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $96 | $185 | $317 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $100 | $171 | $258 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $105 | $190 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $124 | $193 | $255 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $112 | $194 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $78 | $134 | $208 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $126 | $207 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $84 | $161 | $271 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $84 | $140 | $232 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $100 | $171 | $247 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $96 | $193 | $318 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $22 | $51 | $93 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $229 | $493 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $252 | $557 | $1,413 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $197 | $538 | $1,413 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $235 | $391 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $255 | $332 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $96 | $165 | $222 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $181 | $393 | $999 |