| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $80 | $84 | $94 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $94 | $94 | $94 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $59 | $63 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $29 | $32 | $35 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $31 | $35 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $28 | $32 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $30 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $38 | $39 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $28 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $17 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $262 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $102 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $73 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $48 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $82 | $156 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $96 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $155 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $45 | $45 | $45 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $69 | $88 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $112 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $79 | $97 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $123 | $127 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $89 | $89 | $89 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $110 | $129 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $158 | $158 | $158 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $87 | $87 | $87 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $37 | $67 | $97 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $97 | $99 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $107 | $109 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $79 | $79 | $79 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $117 | $120 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $20 | $60 | $100 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $39 | $40 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $69 | $126 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $301 | $423 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $242 | $242 | $242 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $154 | $160 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $151 | $166 | $196 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $118 | $122 | $131 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $98 | $165 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $167 | $167 | $167 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $50 | $109 | $168 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $200 | $370 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $56 | $247 | $438 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,051 | $1,165 | $1,278 |