| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $63 | $76 | $89 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $83 | $89 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $43 | $58 | $79 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $33 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $28 | $36 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $27 | $36 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $30 | $37 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $37 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $33 | $44 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $18 | $35 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $343 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $241 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $102 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $103 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $46 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $191 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $136 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $207 | $227 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $43 | $43 | $43 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $101 | $126 | $150 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $106 | $138 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $122 | $137 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $113 | $145 | $185 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $129 | $137 | $149 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $118 | $121 | $125 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $137 | $164 | $191 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $90 | $95 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $8 | $82 | $144 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $72 | $98 | $143 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $82 | $102 | $118 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $116 | $119 | $123 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $132 | $143 | $154 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $12 | $110 | $160 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $38 | $48 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $133 | $187 | $242 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $285 | $398 | $456 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $453 | $455 | $456 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $141 | $151 | $170 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $154 | $199 | $245 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $121 | $137 | $164 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $190 | $255 | $288 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $309 | $339 | $369 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $132 | $158 | $183 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $309 | $391 | $472 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $240 | $240 | $240 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $865 | $1,192 | $1,518 |