| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $11 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $11 | $11 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $22 | $24 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $25 | $28 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $23 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $21 | $22 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $79 | $83 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $81 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $79 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $55 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $31 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $26 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $25 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $12 | $15 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $268 | $268 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $257 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $89 | $92 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $19 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $77 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $35 | $37 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $108 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $73 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $181 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $107 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $96 | $104 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $113 | $122 | $137 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $118 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $123 | $126 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $136 | $148 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $82 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $51 | $89 | $115 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $73 | $88 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $103 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $89 | $93 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $115 | $119 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $13 | $82 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $4 | $4 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $184 | $184 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $163 | $235 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $90 | $163 | $235 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $152 | $163 |