| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $128 | $128 | $128 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $87 | $87 | $87 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $43 | $55 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $49 | $52 | $55 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $48 | $48 | $48 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $52 | $52 | $52 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $60 | $60 | $60 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $53 | $53 | $53 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $18 | $32 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $11 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $32 | $33 | $33 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $16 | $17 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $334 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $275 | $310 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $107 | $122 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $24 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $75 | $88 | $116 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $60 | $62 | $64 |
| Varicella vaccine CPT 90716 • Preventive Care | $129 | $163 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $54 | $83 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $211 | $259 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $41 | $41 | $41 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $141 | $155 | $162 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $175 | $186 | $207 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $172 | $187 | $216 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $188 | $244 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $188 | $212 | $237 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $214 | $274 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $234 | $237 | $239 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $123 | $178 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $111 | $148 | $191 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $140 | $157 | $190 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $149 | $208 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $155 | $184 | $213 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $172 | $190 | $227 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $189 | $244 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $53 | $58 | $61 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $267 | $267 | $267 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $764 | $764 | $764 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $764 | $764 | $764 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $131 | $197 | $296 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $210 | $305 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $153 | $203 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $299 | $453 | $530 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $300 | $300 | $300 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $248 | $467 | $612 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $349 | $528 | $658 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $371 | $600 | $742 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,774 | $1,774 | $1,774 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $183 | $183 | $183 |