| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $70 | $75 | $80 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $70 | $75 | $80 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $51 | $54 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $26 | $28 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $25 | $26 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $24 | $24 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $25 | $26 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $25 | $26 | $28 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $21 | $23 | $25 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $23 | $24 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $16 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $15 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $336 | $359 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $257 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $112 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $5 | $17 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $106 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $48 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $188 | $205 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $131 | $135 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $215 | $236 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $5 | $45 | $85 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $82 | $111 | $128 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $91 | $105 | $120 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $69 | $104 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $69 | $100 | $131 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $5 | $60 | $115 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $5 | $65 | $125 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $46 | $66 | $87 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $40 | $74 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $71 | $72 | $74 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $5 | $75 | $96 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $5 | $79 | $131 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $104 | $141 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $5 | $52 | $100 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $32 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $65 | $65 | $65 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $231 | $231 | $231 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $430 | $430 | $430 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $88 | $88 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $109 | $109 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $184 | $268 | $352 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $164 | $176 | $187 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $164 | $176 | $187 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $192 | $306 | $420 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $455 | $474 | $493 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $294 | $300 | $307 |