| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $9 | $9 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $10 | $11 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $24 | $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 | $18 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $13 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $68 | $72 | $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 | $47 | $49 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $26 | $26 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $21 | $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 | $32 | $33 | $35 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $28 | $28 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $15 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $6 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $9 | $16 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $253 | $253 | $253 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $214 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $94 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $96 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $29 | $34 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $190 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $113 | $113 | $113 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $232 | $245 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $90 | $96 | $99 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $97 | $103 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $101 | $104 | $107 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $91 | $109 | $122 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $92 | $105 | $118 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $106 | $116 | $127 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $148 | $148 | $148 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $62 | $76 | $91 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $104 | $104 | $104 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $94 | $95 | $97 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $97 | $97 | $97 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $105 | $111 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $111 | $112 | $113 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $113 | $119 | $122 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $33 | $35 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $311 | $311 | $311 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $149 | $149 | $150 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $149 | $149 | $149 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $116 | $118 | $121 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $250 | $250 | $251 |