| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $79 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $79 | $89 | $106 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $53 | $61 | $72 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $38 | $49 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $28 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $27 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $34 | $43 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $38 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $11 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $16 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $271 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $88 | $93 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $66 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $42 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $141 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $82 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $191 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $81 | $81 | $81 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $83 | $101 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $117 | $124 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $119 | $150 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $112 | $129 | $144 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $120 | $130 | $142 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $154 | $164 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $139 | $158 | $175 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $102 | $106 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $70 | $115 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $88 | $101 | $113 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $127 | $144 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $97 | $109 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $105 | $121 | $136 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $15 | $92 | $146 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $27 | $35 | $41 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $145 | $165 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $270 | $413 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $324 | $413 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $168 | $178 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $160 | $184 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $122 | $125 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $131 | $334 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $191 | $353 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $50 | $185 | $335 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $139 | $356 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $17 | $237 | $421 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $282 | $948 | $1,278 |