| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $74 | $74 | $74 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $47 | $60 | $74 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $41 | $50 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $35 | $49 | $63 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $15 | $22 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $15 | $20 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $30 | $45 | $60 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $23 | $32 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $27 | $36 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $18 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $22 | $39 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $14 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $388 | $388 | $388 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $304 | $397 | $489 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $120 | $171 | $222 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $26 | $34 | $42 |
| MMR vaccine CPT 90707 • Preventive Care | $114 | $145 | $205 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $65 | $71 |
| Varicella vaccine CPT 90716 • Preventive Care | $226 | $320 | $415 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $138 | $139 | $140 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $254 | $256 | $258 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $52 | $52 | $52 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $118 | $160 | $202 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $124 | $124 | $124 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $93 | $93 | $93 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $156 | $245 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $141 | $141 | $141 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $127 | $127 | $127 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $177 | $177 | $177 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $76 | $91 | $107 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $9 | $68 | $114 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $114 | $153 | $193 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $91 | $93 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $127 | $127 | $127 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $135 | $135 | $135 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $8 | $65 | $109 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $42 | $42 | $42 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $62 | $123 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $368 | $666 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $143 | $245 | $347 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $135 | $202 | $308 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $183 | $245 | $308 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $124 | $184 | $243 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $256 | $257 | $259 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $144 | $144 | $144 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $269 | $269 | $269 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $363 | $363 | $363 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $274 | $330 | $385 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,038 | $1,038 | $1,038 |