| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $12 | $16 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $18 | $28 | $39 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $19 | $29 | $40 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $25 | $34 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $26 | $36 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $16 | $21 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $63 | $108 | $235 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $50 | $106 | $235 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $50 | $106 | $235 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $24 | $53 | $66 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $16 | $30 | $42 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $20 | $30 | $42 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $18 | $28 | $37 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $29 | $40 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $35 | $46 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $30 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $20 | $36 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $18 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $21 | $36 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $12 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $346 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $254 | $271 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $109 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $23 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $103 | $113 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $51 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $203 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $232 | $258 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $71 | $107 | $143 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $64 | $122 | $163 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $162 | $282 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $73 | $164 | $294 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $100 | $145 | $201 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $93 | $160 | $322 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $89 | $209 | $371 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $131 | $187 | $245 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $109 | $147 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $64 | $145 | $260 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $78 | $121 | $156 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $87 | $151 | $283 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $86 | $158 | $289 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $73 | $182 | $362 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $81 | $145 | $199 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $22 | $33 | $40 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $145 | $200 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $201 | $347 | $565 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $197 | $271 | $370 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $172 | $241 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $154 | $192 | $248 |