| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $106 | $146 | $170 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $71 | $116 | $170 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $72 | $108 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $49 | $65 | $82 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $55 | $64 | $73 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $33 | $54 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $43 | $56 | $69 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $42 | $62 | $82 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $50 | $70 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $17 | $45 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $16 | $21 | $26 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $22 | $41 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $15 | $20 | $30 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $310 | $387 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $266 | $316 | $344 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $88 | $114 | $156 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $23 | $26 | $30 |
| MMR vaccine CPT 90707 • Preventive Care | $67 | $101 | $149 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $33 | $53 | $68 |
| Varicella vaccine CPT 90716 • Preventive Care | $114 | $189 | $292 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $116 | $143 | $174 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $202 | $276 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $81 | $81 | $81 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $137 | $150 | $176 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $144 | $169 | $197 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $127 | $170 | $205 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $169 | $219 | $317 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $139 | $154 | $171 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $161 | $215 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $175 | $196 | $214 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $75 | $116 | $158 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $92 | $131 | $169 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $112 | $154 | $180 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $74 | $145 | $198 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $124 | $130 | $140 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $157 | $184 | $216 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $43 | $129 | $216 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $65 | $82 | $100 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $187 | $283 | $379 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $28 | $195 | $375 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $376 | $376 | $376 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $269 | $336 | $391 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $190 | $251 | $293 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $122 | $164 | $210 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $257 | $376 | $501 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $270 | $403 | $537 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $170 | $292 | $474 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $303 | $404 | $564 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $112 | $384 | $728 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $282 | $952 | $1,702 |