| Hot or cold packs application CPT 97010 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $10 | $10 | $10 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $9 | $9 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $11 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $7 | $9 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $16 | $16 | $16 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $28 | $28 | $28 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $19 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $15 | $15 | $15 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $10 | $10 | $10 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $48 | $48 | $48 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $84 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $57 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $30 | $30 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $17 | $17 | $17 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $21 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $24 | $24 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $19 | $19 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $26 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $11 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $274 | $274 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $98 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $97 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $114 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $73 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $187 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $75 | $91 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $82 | $97 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $82 | $99 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $115 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $89 | $89 | $89 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $148 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $67 | $67 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $112 | $112 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $104 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $131 | $131 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $28 | $33 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $102 | $143 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $30 | $30 | $30 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $137 | $163 |