| Office Visit - Basic | $92 | 0% | $92 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $273 | 0% | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $311 | 0% | $311 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $311 | 0% | $311 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $352 | 0% | $352 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $273 | 0% | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | 0% | $233 |
| Office Visit - Established Patient, High Complexity | $420 | 0% | $420 |
| Office Visit - Established Patient, Low Complexity | $212 | 0% | $212 |
| Office Visit - Established Patient, Moderate Complexity | $315 | 0% | $315 |
| Office Visit - New Patient, Low Complexity | $228 | 0% | $228 |
| Office Visit - New Patient, Minor | $159 | 0% | $159 |
| Office Visit - New Patient, Moderate Complexity | $384 | 0% | $384 |
| Physical Therapy - Application of Mechanical Traction | $53 | 0% | $53 |
| Physical Therapy - Electrical Stimulation Therapy | $53 | 0% | $53 |
| Physical Therapy - Low Complexity Evaluation | $126 | 0% | $126 |
| Physical Therapy - Manual Therapy | $80 | 0% | $80 |
| Physical Therapy - Moderate Complexity Evaluation | $179 | 0% | $179 |
| Physical Therapy - Neuromuscular Reeducation | $80 | 0% | $80 |
| Physical Therapy - Therapeutic Activities | $80 | 0% | $80 |
| Physical Therapy - Therapeutic Exercises | $80 | 0% | $80 |
