| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $77 | $79 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $68 | $74 | $79 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $50 | $54 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $29 | $36 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $25 | $32 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $24 | $31 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $28 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $38 | $45 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $33 | $39 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $5 | $11 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $12 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $13 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $341 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $240 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $107 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $22 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $71 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $30 | $43 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $187 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $127 | $130 | $132 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $236 | $245 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $109 | $147 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $87 | $98 | $110 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $119 | $140 | $160 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $97 | $130 | $182 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $110 | $143 | $176 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $139 | $149 | $160 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $221 | $221 | $221 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $71 | $85 | $94 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $84 | $141 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $54 | $91 | $141 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $82 | $111 | $155 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $84 | $117 | $159 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $105 | $137 | $169 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $95 | $110 | $137 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $35 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $76 | $76 | $76 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $84 | $216 | $312 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $442 | $442 | $442 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $152 | $157 | $168 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $151 | $188 | $225 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $118 | $130 | $152 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $178 | $210 | $242 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $179 | $179 | $179 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $336 | $336 | $336 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $211 | $211 | $211 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $488 | $488 | $488 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $299 | $299 | $299 |