| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $76 | $78 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $53 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $29 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $26 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $30 | $30 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $27 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $36 | $37 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $32 | $32 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $19 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $9 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $8 | $16 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $10 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $251 | $283 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $218 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $75 | $86 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $78 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $29 | $36 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $91 | $156 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $50 | $102 | $127 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $143 | $185 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $43 | $43 | $43 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $90 | $97 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $64 | $88 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $85 | $92 | $95 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $104 | $111 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $97 | $112 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $117 | $126 | $149 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $126 | $126 | $126 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $90 | $92 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $76 | $89 | $115 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $56 | $84 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $64 | $93 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $83 | $92 | $105 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $72 | $97 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $100 | $112 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $27 | $30 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $130 | $130 | $130 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $304 | $373 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $211 | $223 | $235 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $158 | $158 | $158 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $147 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $117 | $121 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $299 | $299 | $299 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $146 | $146 | $146 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $147 | $147 | $147 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $321 | $321 | $321 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $250 | $362 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $865 | $865 | $865 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $92 | $92 | $92 |