| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $79 | $83 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $48 | $69 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $44 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $30 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $20 | $25 | $33 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $24 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $21 | $28 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $27 | $36 | $46 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $31 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $16 | $19 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $10 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $4 | $14 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $322 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $315 | $489 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $136 | $222 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $28 | $42 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $112 | $205 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $30 | $51 | $71 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $254 | $415 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $113 | $115 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $227 | $245 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $43 | $43 | $43 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $76 | $91 | $117 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $114 | $122 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $113 | $127 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $111 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $110 | $126 | $140 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $134 | $142 | $150 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $126 | $151 | $176 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $69 | $77 | $91 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $57 | $106 | $193 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $79 | $88 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $97 | $111 | $123 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $89 | $100 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $92 | $107 | $124 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $102 | $157 | $246 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $25 | $28 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $165 | $165 | $165 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $106 | $144 | $185 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $312 | $312 | $312 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $128 | $162 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $114 | $141 | $167 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $77 | $104 | $121 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $131 | $173 | $195 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $218 | $237 | $257 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $40 | $141 | $243 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $266 | $297 | $327 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $348 | $348 | $348 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $658 | $793 | $928 |