| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $87 | $87 | $87 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $60 | $60 | $60 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $29 | $30 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $28 | $28 | $28 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $27 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $29 | $29 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $41 | $41 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $36 | $36 | $36 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $23 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $8 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $19 | $25 | $30 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $15 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $285 | $362 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $284 | $284 | $284 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $112 | $112 | $112 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $14 | $19 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $72 | $89 | $106 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $47 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $124 | $168 | $211 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $113 | $121 | $129 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $194 | $237 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $77 | $77 | $77 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $80 | $80 | $80 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $125 | $153 | $181 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $130 | $153 | $176 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $146 | $179 | $212 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $141 | $149 | $156 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $163 | $201 | $238 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $177 | $177 | $177 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $65 | $86 | $107 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $114 | $134 | $155 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $91 | $123 | $155 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $94 | $126 | $158 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $120 | $143 | $173 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $107 | $107 | $107 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $46 | $46 | $46 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $66 | $66 | $66 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $215 | $215 | $215 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $398 | $398 | $398 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $182 | $182 | $182 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $151 | $161 | $182 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $118 | $126 | $143 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $155 | $155 | $155 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $155 | $155 | $155 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $300 | $300 | $300 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $408 | $408 | $408 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $436 | $436 | $436 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $258 | $258 | $258 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $108 | $108 | $108 |