| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $63 | $73 | $81 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $81 | $81 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $42 | $50 | $55 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $29 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $28 | $31 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $28 | $28 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $29 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $14 | $24 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $29 | $29 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $14 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $175 | $276 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $190 | $226 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $109 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $23 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $72 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $49 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $91 | $134 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $134 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $143 | $203 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $55 | $55 | $55 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $97 | $98 | $99 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $75 | $95 | $105 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $104 | $106 | $108 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $80 | $104 | $117 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $85 | $99 | $113 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $123 | $138 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $115 | $130 | $146 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $55 | $57 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $62 | $82 | $93 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $62 | $82 | $93 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $92 | $98 | $102 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $93 | $98 | $102 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $80 | $91 | $108 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $88 | $101 | $126 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $37 | $49 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $176 | $176 | $176 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $292 | $515 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $46 | $281 | $515 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $73 | $98 | $147 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $151 | $187 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $92 | $103 | $125 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $310 | $344 | $412 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $203 | $304 | $404 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $312 | $369 | $417 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $334 | $395 | $450 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $182 | $369 | $533 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $932 | $1,048 | $1,280 |