| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $68 | $68 | $68 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $45 | $45 | $45 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $29 | $30 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $29 | $39 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $26 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $27 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $31 | $31 | $31 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $28 | $28 | $28 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $23 | $30 | $33 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $16 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $301 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $114 | $126 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $75 | $82 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $57 | $64 |
| Varicella vaccine CPT 90716 • Preventive Care | $129 | $150 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $54 | $101 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $197 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $41 | $41 | $41 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $103 | $142 | $162 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $107 | $152 | $175 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $82 | $142 | $172 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $97 | $139 | $188 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $93 | $140 | $188 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $142 | $170 | $220 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $121 | $180 | $239 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $92 | $109 | $127 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $99 | $116 | $141 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $98 | $126 | $140 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $108 | $126 | $154 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $100 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $118 | $154 | $172 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $139 | $190 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $25 | $49 | $61 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $177 | $177 | $177 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $93 | $206 | $340 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $341 | $341 | $341 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $121 | $158 | $188 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $160 | $163 | $167 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $108 | $122 | $131 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $149 | $403 | $530 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $291 | $291 | $291 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $273 | $452 | $542 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $177 | $368 | $577 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $182 | $356 | $686 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $875 | $1,054 | $1,233 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $83 | $83 | $83 |