| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $74 | $74 | $74 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $50 | $79 | $107 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $25 | $25 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $25 | $25 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $23 | $23 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $24 | $24 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $26 | $26 | $26 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $24 | $24 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $11 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $25 | $34 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $17 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $302 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $272 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $123 | $123 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $96 | $107 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $59 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $31 | $31 | $31 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $48 | $133 | $179 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $83 | $83 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $82 | $82 | $82 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $89 | $164 | $219 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $89 | $134 | $179 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $77 | $142 | $206 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $110 | $159 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $69 | $107 | $175 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $48 | $96 | $144 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $56 | $127 | $199 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $75 | $133 | $190 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $83 | $127 | $172 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $92 | $131 | $198 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $30 | $30 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $107 | $107 | $107 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $170 | $170 | $170 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $316 | $316 | $316 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $84 | $180 | $276 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $155 | $155 | $155 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $104 | $104 | $104 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $260 | $260 | $260 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $286 | $286 | $286 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $102 | $111 | $121 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $124 | $204 | $284 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $133 | $145 | $157 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $333 | $577 | $822 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $73 | $73 | $73 |