| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $88 | $88 | $88 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $60 | $68 | $75 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $32 | $35 | $40 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $35 | $35 | $35 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $34 | $34 | $34 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $36 | $36 | $36 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $51 | $51 | $51 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $43 | $43 | $43 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $21 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $13 | $13 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $10 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $10 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $345 | $345 | $345 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $113 | $259 | $540 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $68 | $122 | $245 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $23 | $23 | $23 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $61 | $102 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $43 | $52 |
| Varicella vaccine CPT 90716 • Preventive Care | $83 | $113 | $201 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $52 | $90 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $226 | $393 | $560 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $49 | $49 | $49 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $83 | $101 | $119 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $96 | $110 | $124 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $112 | $129 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $106 | $107 | $111 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $101 | $115 | $142 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $96 | $136 | $164 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $139 | $139 | $139 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $107 | $107 | $107 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $64 | $74 | $83 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $45 | $88 | $114 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $51 | $90 | $124 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $87 | $100 | $128 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $98 | $117 | $136 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $108 | $129 | $153 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $21 | $33 | $43 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $189 | $189 | $189 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $82 | $162 | $202 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $217 | $306 | $357 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $136 | $164 | $191 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $162 | $228 | $406 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $108 | $121 | $143 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $261 | $289 | $317 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $290 | $290 | $290 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $127 | $199 | $271 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $371 | $371 | $371 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $192 | $326 | $461 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,185 | $1,380 | $1,575 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $100 | $100 | $100 |