| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $83 | $83 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $57 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $33 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $29 | $33 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $28 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $29 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $42 | $46 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $36 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $20 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $15 | $16 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $441 | $554 |
| 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 | $22 | $29 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $74 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $60 | $65 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $134 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $99 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $245 | $363 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $48 | $48 | $48 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $111 | $124 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $116 | $130 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $115 | $120 | $135 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $139 | $153 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $134 | $138 | $148 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $155 | $161 | $172 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $145 | $154 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $104 | $112 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $37 | $82 | $120 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $73 | $102 | $119 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $119 | $122 | $131 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $102 | $114 | $121 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $128 | $132 | $143 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $50 | $111 | $153 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $5 | $31 | $43 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $183 | $185 | $190 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $169 | $240 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $338 | $349 | $359 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $169 | $186 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $170 | $192 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $128 | $130 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $90 | $269 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $118 | $295 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $105 | $154 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $117 | $376 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $208 | $400 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,067 | $1,225 | $1,278 |