| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $81 | $81 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $55 | $55 | $55 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $31 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $31 | $31 | $31 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $28 | $28 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $29 | $38 | $42 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $43 | $48 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $38 | $42 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $24 | $29 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $15 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $21 | $28 | $31 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $14 | $16 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $114 | $162 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $70 | $80 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $24 | $54 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $42 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $85 | $120 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $53 | $74 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $216 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $40 | $40 | $40 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $90 | $124 | $141 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $98 | $131 | $147 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $98 | $135 | $154 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $78 | $142 | $174 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $107 | $148 | $169 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $125 | $159 | $195 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $105 | $176 | $212 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $76 | $98 | $127 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $60 | $99 | $136 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $84 | $118 | $135 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $93 | $130 | $148 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $69 | $112 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $134 | $162 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $114 | $154 | $174 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $44 | $48 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $60 | $105 | $172 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $82 | $315 | $494 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $172 | $293 | $494 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $134 | $185 | $210 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $170 | $201 | $217 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $114 | $134 | $145 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $294 | $362 | $396 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $145 | $328 | $420 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $196 | $296 | $396 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $169 | $340 | $426 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $381 | $447 | $480 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $914 | $914 | $914 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $90 | $111 | $122 |