| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $76 | $79 | $83 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $81 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $79 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $55 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $28 | $30 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $26 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $25 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $21 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $6 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $316 | $316 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $257 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $89 | $92 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $66 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $38 | $40 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $124 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $13 | $13 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $19 | $97 | $176 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $101 | $105 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $112 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $113 | $115 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $105 | $121 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $103 | $118 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $142 | $146 | $149 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $159 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $50 | $89 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $88 | $95 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $90 | $101 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $101 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $98 | $114 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $71 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $14 | $26 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $184 | $184 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $68 | $214 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $195 | $195 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $152 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $119 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $26 | $26 | $26 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $84 | $139 |