| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $79 | $82 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $101 | $118 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $53 | $56 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $30 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $30 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $36 | $52 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $30 | $32 |
| 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 | $15 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $18 | $20 | $22 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $18 | $25 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $16 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $278 | $303 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $95 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $27 | $32 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $75 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $43 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $124 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $88 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $169 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $71 | $71 | $71 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $131 | $170 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $137 | $177 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $100 | $133 | $185 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $139 | $146 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $112 | $158 | $203 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $147 | $153 | $164 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $151 | $203 | $255 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $75 | $75 | $75 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $65 | $119 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $83 | $95 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $94 | $103 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $100 | $100 | $100 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $112 | $143 | $195 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $131 | $141 | $160 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $5 | $32 | $51 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $80 | $132 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $170 | $284 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $284 | $284 | $284 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $138 | $155 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $179 | $190 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $139 | $162 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $202 | $334 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $215 | $244 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $131 | $147 | $163 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $287 | $484 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $129 | $349 | $569 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $955 | $1,170 | $1,278 |