| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $83 | $102 | $156 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $57 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $41 | $55 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $30 | $33 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $28 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $31 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $43 | $46 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $36 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $18 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $19 | $29 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $19 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $271 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $95 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $68 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $51 | $65 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $124 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $65 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $201 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $49 | $49 | $49 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $120 | $152 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $87 | $103 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $115 | $131 | $165 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $135 | $144 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $159 | $212 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $127 | $156 | $195 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $167 | $175 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $101 | $105 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $15 | $89 | $156 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $82 | $110 | $145 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $93 | $102 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $95 | $124 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $138 | $173 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $13 | $119 | $190 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $8 | $29 | $41 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $60 | $122 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $142 | $200 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $90 | $145 | $201 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $167 | $175 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $169 | $180 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $122 | $136 | $169 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $153 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $250 | $277 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $66 | $166 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $244 | $353 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $74 | $238 | $376 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $332 | $972 | $1,278 |