| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $82 | $88 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $60 | $68 | $76 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $40 | $43 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $21 | $27 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $26 | $35 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $20 | $21 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $28 | $36 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $14 | $29 | $39 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $27 | $34 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $26 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $12 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $12 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $16 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $344 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $275 | $386 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $99 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $25 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $96 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $48 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $177 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $146 | $201 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $199 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $37 | $37 | $37 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $66 | $103 | $172 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $96 | $123 | $180 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $84 | $133 | $187 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $113 | $154 | $210 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $82 | $128 | $204 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $99 | $128 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $142 | $199 | $256 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $83 | $90 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $61 | $83 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $79 | $110 | $165 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $88 | $97 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $71 | $81 | $98 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $104 | $134 | $196 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $111 | $161 | $211 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $38 | $47 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $31 | $31 | $31 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $266 | $302 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $265 | $265 | $265 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $106 | $210 | $261 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $142 | $189 | $261 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $94 | $115 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $38 | $170 | $273 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $249 | $299 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $301 | $301 | $301 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $252 | $275 | $297 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $296 | $296 | $296 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $839 | $888 | $938 |