| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $51 | $61 | $66 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $31 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $29 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $25 | $29 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $29 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $29 | $37 | $45 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $32 | $38 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $23 | $23 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $20 | $22 | $23 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $78 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $49 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $213 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $250 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $47 | $47 | $47 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $87 | $92 | $95 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $67 | $83 | $98 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $98 | $102 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $88 | $102 | $116 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $103 | $108 | $113 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $120 | $120 | $120 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $102 | $122 | $141 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $50 | $55 | $60 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $59 | $72 | $91 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $81 | $81 | $81 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $89 | $89 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $89 | $89 | $89 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $76 | $92 | $108 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $43 | $76 | $110 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $43 | $49 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $71 | $119 | $166 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $415 | $455 | $495 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $220 | $255 | $290 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $171 | $213 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $164 | $189 | $213 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $110 | $138 | $166 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $338 | $383 | $412 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $172 | $310 | $447 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $173 | $196 | $219 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $201 | $386 | $570 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $447 | $447 | $447 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,034 | $1,552 | $2,069 |