| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $8 | $8 | $8 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $21 | $21 | $21 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $18 | $18 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $16 | $16 | $16 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $61 | $61 | $61 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $43 | $43 | $43 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $17 | $17 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $20 | $20 | $20 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $19 | $20 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $20 | $20 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $23 | $23 | $23 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $25 | $25 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $394 | $394 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $271 | $271 | $271 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $140 | $140 | $140 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $258 | $258 | $258 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $94 | $112 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $52 | $52 | $52 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $57 | $57 | $57 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $87 | $87 | $87 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $104 | $108 | $112 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $159 | $159 | $159 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $233 | $233 | $233 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $74 | $74 | $74 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $109 | $109 | $110 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $109 | $109 | $109 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $107 | $107 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $282 | $282 | $282 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $89 | $89 |
| Spirometry CPT 94010 • Pulmonology | $44 | $44 | $44 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $25 | $25 | $25 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $44 | $44 | $44 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $56 | $56 | $56 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $45 | $45 | $45 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $1 | $1 | $1 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $28 | $28 | $28 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $72 | $72 | $72 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $205 | $205 | $205 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $55 | $55 | $55 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $162 | $162 | $162 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $22 | $22 | $22 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $1,382 | $1,382 | $1,382 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $62 | $62 | $62 |