| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $74 | $81 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $74 | $80 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $50 | $55 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $31 | $32 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $29 | $32 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $27 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $28 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $38 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $31 | $33 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $14 | $23 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $301 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $257 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $95 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $94 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $41 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $170 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $88 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $197 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $43 | $43 | $43 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $103 | $105 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $108 | $110 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $112 | $114 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $95 | $119 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $123 | $126 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $142 | $146 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $154 | $157 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $92 | $94 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $72 | $94 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $98 | $100 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $81 | $101 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $110 | $112 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $117 | $121 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $122 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $37 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $134 | $171 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $266 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $338 | $358 | $378 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $150 | $160 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $159 | $162 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $122 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $58 | $141 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $126 | $319 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $98 | $300 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $103 | $323 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $144 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $221 | $1,014 | $1,278 |