| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $53 | $53 | $53 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $61 | $61 | $61 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $28 | $32 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $21 | $21 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $28 | $28 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $21 | $21 | $21 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $30 | $30 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $26 | $26 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $9 | $19 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $8 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $23 | $45 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $17 | $32 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $197 | $245 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $113 | $192 | $310 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $61 | $82 | $111 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $26 | $26 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $73 | $112 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $44 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $83 | $169 | $228 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $52 | $58 | $70 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $129 | $140 | $151 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $103 | $103 | $103 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $88 | $126 | $149 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $96 | $139 | $170 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $115 | $133 | $140 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $106 | $140 | $199 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $81 | $109 | $144 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $94 | $138 | $185 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $79 | $135 | $192 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $44 | $83 | $125 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $47 | $104 | $156 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $65 | $116 | $156 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $71 | $119 | $171 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $87 | $129 | $160 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $127 | $185 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $84 | $104 | $119 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $33 | $42 | $59 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $108 | $108 | $108 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $183 | $190 | $204 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $204 | $274 | $343 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $228 | $274 | $321 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $162 | $184 | $227 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $125 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $467 | $494 | $521 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $83 | $83 | $83 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $155 | $155 | $155 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $212 | $212 | $212 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $782 | $782 | $782 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $463 | $463 | $463 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $199 | $199 | $199 |