| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $73 | $78 | $83 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $78 | $84 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $51 | $54 | $58 |
| 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 | $27 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $26 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $26 | $30 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $38 | $40 | $43 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $35 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $16 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $290 | $319 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $250 | $255 | $257 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $96 | $99 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $85 | $94 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $40 | $48 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $176 | $186 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $114 | $128 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $187 | $209 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $37 | $37 | $37 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $101 | $105 | $110 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $113 | $115 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $115 | $117 | $120 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $133 | $135 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $98 | $116 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $144 | $147 | $152 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $161 | $165 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $70 | $87 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $97 | $104 | $115 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $101 | $103 | $105 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $102 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $118 | $124 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $97 | $117 | $140 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $50 | $116 | $135 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $28 | $35 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $174 | $179 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $169 | $233 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $188 | $239 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $151 | $168 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $115 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $162 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $65 | $186 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $131 | $221 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $152 | $251 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $253 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,094 | $1,217 | $1,278 |