| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $79 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $77 | $78 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $59 | $67 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $30 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $29 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $28 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $27 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $33 | $37 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $33 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $17 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $9 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $11 | $15 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $10 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $347 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $265 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $105 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $71 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $47 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $193 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $74 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $164 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $42 | $42 | $42 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $92 | $112 | $138 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $102 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $111 | $115 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $152 | $170 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $126 | $127 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $152 | $158 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $137 | $172 | $208 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $90 | $90 | $91 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $69 | $98 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $113 | $133 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $97 | $106 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $93 | $121 | $149 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $118 | $133 | $158 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $134 | $170 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $40 | $47 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $80 | $132 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $324 | $484 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $255 | $275 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $185 | $206 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $169 | $213 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $122 | $136 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $110 | $189 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $348 | $348 | $348 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $209 | $388 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $224 | $417 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $37 | $141 | $247 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,124 | $1,201 | $1,278 |