| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $66 | $73 | $80 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $80 | $80 | $80 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $66 | $73 | $80 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $45 | $50 | $54 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $26 | $28 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $24 | $26 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $23 | $24 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $24 | $26 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $28 | $29 | $31 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $26 | $27 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $8 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $175 | $285 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $190 | $217 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $74 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $50 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $91 | $137 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $50 | $95 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $94 | $99 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $71 | $90 | $106 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $71 | $77 | $91 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $106 | $113 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $99 | $106 | $113 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $128 | $134 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $125 | $127 | $128 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $67 | $67 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $62 | $68 | $74 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $62 | $73 | $82 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $71 | $81 | $92 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $69 | $75 | $82 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $80 | $83 | $90 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $100 | $104 | $108 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $34 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $143 | $154 | $165 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $62 | $215 | $430 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $231 | $231 | $231 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $132 | $156 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $149 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $87 | $94 | $109 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $162 | $209 | $237 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $253 | $320 | $387 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $359 | $359 | $359 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $321 | $352 | $383 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $455 | $455 | $455 |