| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $84 | $91 | $98 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $66 | $83 | $98 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $98 | $98 | $98 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $59 | $67 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $32 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $35 | $42 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $26 | $32 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $28 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $30 | $31 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $30 | $33 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $29 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $15 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $33 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $16 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $334 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $263 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $108 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $23 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $75 | $89 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $62 | $64 |
| Varicella vaccine CPT 90716 • Preventive Care | $129 | $163 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $54 | $109 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $219 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $41 | $41 | $41 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $118 | $148 | $162 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $128 | $159 | $175 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $85 | $143 | $172 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $152 | $188 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $136 | $162 | $188 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $161 | $200 | $220 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $129 | $184 | $239 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $64 | $95 | $127 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $101 | $115 | $141 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $105 | $140 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $111 | $127 | $154 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $112 | $134 | $155 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $124 | $156 | $172 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $136 | $172 | $190 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $43 | $55 | $61 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $159 | $159 | $159 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $170 | $323 | $489 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $309 | $399 | $489 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $111 | $133 | $156 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $177 | $206 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $131 | $137 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $415 | $492 | $530 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $201 | $227 | $253 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $248 | $405 | $542 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $349 | $459 | $577 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $322 | $513 | $686 |