| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $78 | $81 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $78 | $78 | $78 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $53 | $55 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $34 | $34 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $34 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $28 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $32 | $32 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $37 | $37 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $33 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $23 | $35 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $18 | $18 | $18 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $23 | $35 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $378 | $378 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $277 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $105 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $26 | $26 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $63 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $57 | $57 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $192 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $74 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $138 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $65 | $65 | $65 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $132 | $157 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $138 | $164 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $143 | $171 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $163 | $194 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $188 | $188 | $188 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $183 | $218 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $236 | $236 | $236 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $127 | $151 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $126 | $151 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $119 | $126 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $169 | $169 | $169 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $151 | $180 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $79 | $149 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $29 | $54 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $102 | $143 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $397 | $615 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $349 | $349 | $349 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $173 | $182 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $203 | $242 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $144 | $161 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $135 | $240 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $522 | $522 | $522 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $137 | $243 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $280 | $530 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $56 | $326 | $597 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $385 | $832 | $1,278 |