| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $71 | $77 | $82 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $82 | $82 | $82 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $49 | $52 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $39 | $39 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $34 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $28 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $37 | $37 | $37 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $46 | $46 | $46 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $37 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $21 | $32 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $16 | $16 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $18 | $26 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $15 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $97 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $100 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $50 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $104 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $69 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $201 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $71 | $71 | $71 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $107 | $114 | $121 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $146 | $180 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $135 | $154 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $146 | $161 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $127 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $147 | $167 | $188 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $259 | $259 | $259 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $90 | $90 | $90 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $105 | $136 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $99 | $101 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $130 | $148 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $152 | $152 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $142 | $162 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $20 | $97 | $174 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $21 | $36 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $73 | $129 | $185 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $335 | $490 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $490 | $490 | $490 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $168 | $191 | $213 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $168 | $218 | $269 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $131 | $157 | $182 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $295 | $334 | $374 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $423 | $423 | $423 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $189 | $203 | $217 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $273 | $515 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $283 | $327 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $291 | $884 | $1,477 |