| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $20 | $20 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $22 | $22 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $32 | $32 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $27 | $27 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $185 | $185 | $185 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $185 | $185 | $185 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $145 | $145 | $145 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $96 | $96 | $96 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $1,139 | $1,584 | $2,030 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $1,036 | $1,036 | $1,036 |
| Sleep study unattended CPT 95800 • Sleep Medicine | $174 | $174 | $174 |
| Sleep study unattended minimum 3 channels CPT 95801 • Sleep Medicine | $97 | $97 | $97 |
| CPAP combination oral/nasal mask HCPCS A7027 • Sleep Medicine | $81 | $81 | $81 |
| Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine | $879 | $879 | $879 |
| CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine | $369 | $369 | $369 |