| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $74 | $75 | $76 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $74 | $75 | $76 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $31 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $24 | $24 | $25 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $23 | $23 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $24 | $25 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $31 | $33 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $316 | $316 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $80 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $70 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $36 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $132 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $73 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $19 | $127 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $101 | $103 | $104 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $108 | $110 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $108 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $121 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $103 | $116 | $123 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $134 | $142 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $153 | $153 | $153 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $93 | $95 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $73 | $92 | $104 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $73 | $92 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $104 | $108 | $111 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $92 | $103 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $115 | $117 | $117 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $114 | $127 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $23 | $24 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $114 | $114 | $115 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $251 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $287 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $99 | $99 | $99 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $98 | $109 | $130 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $77 | $102 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $269 | $269 | $269 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $297 | $297 | $297 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $205 | $379 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $114 | $172 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,383 | $1,383 | $1,383 |