| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $17 | $36 | $61 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $13 | $29 | $54 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $21 | $29 | $51 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $20 | $33 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $70 | $100 | $149 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $56 | $109 | $162 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $56 | $89 | $139 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $38 | $69 | $95 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $18 | $42 | $70 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $34 | $61 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $34 | $58 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $38 | $64 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $26 | $52 | $89 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $43 | $78 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $22 | $43 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $8 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $15 | $22 | $39 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $14 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $161 | $320 | $493 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $174 | $287 | $439 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $98 | $116 | $136 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $33 | $93 |
| MMR vaccine CPT 90707 • Preventive Care | $73 | $100 | $130 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $48 | $68 |
| Varicella vaccine CPT 90716 • Preventive Care | $90 | $191 | $288 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $90 | $129 | $196 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $226 | $286 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $44 | $44 | $44 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $57 | $107 | $188 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $60 | $119 | $196 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $63 | $117 | $204 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $72 | $133 | $232 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $71 | $136 | $225 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $86 | $167 | $260 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $95 | $171 | $281 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $52 | $109 | $170 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $59 | $118 | $180 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $59 | $114 | $180 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $63 | $116 | $197 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $65 | $115 | $201 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $70 | $124 | $216 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $75 | $143 | $232 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $48 | $71 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $59 | $176 | $323 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $243 | $416 | $626 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $160 | $378 | $626 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $86 | $188 | $273 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $150 | $207 | $299 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $90 | $139 | $214 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $57 | $220 | $394 |