| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $75 | $76 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $51 | $57 | $63 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $32 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $26 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $29 | $29 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $30 | $30 | $30 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $39 | $43 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $37 | $37 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $13 | $16 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $9 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $14 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $14 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $150 | $260 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $228 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $93 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $84 | $97 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $44 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $176 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $190 | $203 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $40 | $40 | $40 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $90 | $90 | $91 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $87 | $92 | $97 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $101 | $121 | $142 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $161 | $170 | $179 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $140 | $152 | $161 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $139 | $159 | $180 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $152 | $178 | $204 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $117 | $120 | $123 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $91 | $111 | $131 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $97 | $111 | $125 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $103 | $104 | $106 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $99 | $122 | $140 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $98 | $124 | $149 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $122 | $151 | $179 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $39 | $47 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $207 | $207 | $207 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $391 | $391 | $391 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $391 | $391 | $391 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $194 | $194 | $194 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $199 | $199 | $199 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $135 | $149 | $163 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $157 | $157 | $157 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $318 | $318 | $318 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $161 | $161 | $161 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $407 | $407 | $407 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $432 | $432 | $432 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $265 | $265 | $265 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $109 | $109 | $109 |