| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $56 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $27 | $27 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $28 | $28 | $28 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $25 | $25 | $25 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $27 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $29 | $29 | $29 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $26 | $26 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $24 | $33 | $43 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $17 | $22 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $28 | $43 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $18 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $369 | $382 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $242 | $257 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $110 | $117 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $105 | $111 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $42 | $51 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $206 | $218 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $144 | $147 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $242 | $262 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $35 | $35 | $35 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $54 | $123 | $191 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $92 | $146 | $200 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $91 | $150 | $208 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $167 | $236 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $69 | $69 | $69 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $126 | $126 | $126 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $96 | $124 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $76 | $130 | $184 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $76 | $130 | $184 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $118 | $153 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $62 | $134 | $206 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $69 | $144 | $219 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $103 | $103 | $103 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $33 | $33 | $33 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $54 | $54 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $189 | $189 | $189 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $189 | $189 | $189 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $93 | $93 | $93 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $172 | $172 | $172 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $115 | $121 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $289 | $289 | $289 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $134 | $134 | $134 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $134 | $134 | $134 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $316 | $316 | $316 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $378 | $378 | $378 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $246 | $246 | $246 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $81 | $81 | $81 |