| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $70 | $89 | $107 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $70 | $70 | $70 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $48 | $48 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $33 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $31 | $36 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $25 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $32 | $37 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $21 | $39 | $51 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $21 | $25 | $29 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $12 | $20 | $26 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $14 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $18 | $20 | $25 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $16 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $342 | $369 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $243 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $107 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $5 | $17 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $101 | $107 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $46 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $200 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $129 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $224 | $241 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $39 | $39 | $39 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $5 | $89 | $124 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $5 | $90 | $129 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $5 | $94 | $135 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $5 | $107 | $177 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $111 | $146 | $171 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $5 | $119 | $199 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $5 | $127 | $182 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $83 | $98 | $112 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $79 | $119 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $66 | $92 | $118 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $5 | $90 | $129 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $5 | $103 | $155 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $92 | $132 | $165 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $87 | $122 | $151 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $33 | $39 | $43 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $113 | $113 | $113 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $85 | $193 | $418 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $184 | $340 | $418 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $107 | $168 | $189 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $142 | $173 | $188 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $95 | $131 | $149 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $184 | $276 | $311 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $187 | $284 | $336 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $128 | $289 | $394 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $218 | $338 | $428 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $163 | $293 | $453 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $307 | $1,039 | $1,549 |