| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $22 | $22 | $22 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $25 | $25 | $25 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $26 | $26 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $22 | $22 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $35 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $22 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $8 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $16 | $16 | $16 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $12 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $316 | $316 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $197 | $197 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $99 | $99 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $19 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $91 | $91 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $29 | $29 | $29 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $184 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $113 | $113 | $113 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $207 | $207 | $207 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $101 | $101 | $101 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $113 | $113 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $118 | $118 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $133 | $133 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $96 | $96 | $96 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $149 | $149 | $149 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $98 | $98 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $97 | $97 | $97 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $104 | $104 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $116 | $116 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $123 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $133 | $133 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $32 | $32 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $235 | $235 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $195 | $195 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $130 | $130 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $121 | $121 | $121 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $110 | $110 | $110 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $56 | $56 | $56 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $139 | $139 |
| Spirometry CPT 94010 • Pulmonology | $7 | $7 | $7 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $32 | $32 | $32 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $36 | $36 | $36 |