| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $70 | $76 | $80 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $70 | $70 | $70 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $41 | $48 | $55 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $28 | $29 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $26 | $28 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $25 | $25 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $24 | $25 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $34 | $35 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $29 | $31 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $9 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $8 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $103 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $15 | $17 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $100 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $48 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $213 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $117 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $216 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $80 | $97 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $95 | $107 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $98 | $105 | $112 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $91 | $107 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $71 | $97 | $122 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $87 | $103 | $120 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $93 | $124 | $154 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $65 | $73 | $81 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $14 | $47 | $71 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $48 | $75 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $63 | $88 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $97 | $106 | $115 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $71 | $95 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $9 | $71 | $121 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $26 | $31 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $142 | $154 | $166 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $150 | $185 | $219 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $90 | $122 | $153 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $124 | $152 | $179 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $125 | $142 | $151 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $84 | $107 | $118 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $160 | $241 | $302 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $183 | $237 | $291 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $87 | $123 | $159 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $269 | $321 | $373 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $164 | $298 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $827 | $1,059 | $1,290 |