| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $89 | $95 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $84 | $89 | $95 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $58 | $61 | $64 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $32 | $36 | $40 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $30 | $32 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $28 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $31 | $31 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $34 | $34 | $34 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $30 | $30 | $30 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $18 | $28 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $24 | $30 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $17 | $24 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $313 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $251 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $14 | $19 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $62 | $84 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $49 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $107 | $154 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $45 | $100 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $218 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $40 | $40 | $40 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $62 | $108 | $132 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $133 | $181 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $71 | $114 | $176 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $80 | $124 | $168 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $114 | $145 | $193 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $133 | $183 | $238 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $145 | $170 | $194 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $65 | $76 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $62 | $68 | $74 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $83 | $95 | $114 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $71 | $111 | $169 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $86 | $113 | $158 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $80 | $103 | $136 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $97 | $115 | $131 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $38 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $136 | $136 | $136 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $185 | $367 | $510 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $404 | $407 | $410 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $107 | $148 | $168 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $168 | $183 | $198 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $131 | $132 | $132 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $333 | $333 | $333 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $366 | $418 | $471 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $202 | $271 | $340 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $363 | $415 | $467 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $262 | $348 | $434 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $283 | $880 | $1,477 |