| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $70 | $114 | $136 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $99 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $55 | $72 | $93 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $42 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $39 | $47 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $28 | $42 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $33 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $33 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $36 | $43 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $27 | $40 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $17 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $21 | $28 | $38 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $16 | $24 | $37 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $175 | $254 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $190 | $251 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $95 | $137 | $233 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $72 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $76 | $98 |
| Varicella vaccine CPT 90716 • Preventive Care | $91 | $152 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $135 | $228 | $328 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $143 | $215 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $130 | $130 | $130 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $66 | $184 | $269 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $152 | $206 | $282 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $150 | $201 | $294 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $85 | $168 | $231 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $163 | $221 | $321 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $174 | $206 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $153 | $261 | $405 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $57 | $96 | $136 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $10 | $93 | $142 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $125 | $147 | $171 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $75 | $141 | $188 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $71 | $111 | $160 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $114 | $191 | $310 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $85 | $135 | $186 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $45 | $55 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $176 | $176 | $176 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $252 | $333 | $434 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $258 | $305 | $362 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $73 | $168 | $276 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $156 | $206 | $275 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $87 | $162 | $217 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $183 | $472 | $1,117 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $524 | $870 | $1,215 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $221 | $514 | $1,152 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $219 | $680 | $1,452 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $133 | $350 | $533 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $304 | $1,799 | $3,289 |