| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $22 | $34 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $20 | $34 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $27 | $45 | $70 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $24 | $48 | $79 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $40 | $70 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $40 | $66 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $29 | $48 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $58 | $144 | $271 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $69 | $151 | $271 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $69 | $147 | $271 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $28 | $82 | $160 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $54 | $87 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $47 | $79 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $47 | $75 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $49 | $82 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $65 | $115 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $53 | $98 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $31 | $55 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $13 | $29 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $29 | $50 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $21 | $35 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $144 | $316 | $398 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $331 | $568 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $98 | $115 | $135 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $23 | $30 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $104 | $127 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $56 | $88 |
| Varicella vaccine CPT 90716 • Preventive Care | $120 | $196 | $237 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $119 | $169 | $294 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $244 | $402 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $92 | $92 | $92 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $57 | $132 | $224 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $93 | $152 | $234 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $63 | $137 | $242 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $81 | $156 | $275 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $71 | $159 | $266 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $86 | $200 | $400 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $95 | $225 | $354 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $52 | $121 | $212 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $55 | $134 | $240 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $55 | $117 | $213 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $63 | $141 | $261 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $99 | $156 | $237 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $70 | $149 | $255 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $75 | $155 | $276 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $54 | $92 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $51 | $206 | $493 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $314 | $531 | $810 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $213 | $512 | $811 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $130 | $269 | $388 |