| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $95 | $146 | $245 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $98 | $196 | $245 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $58 | $61 | $67 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $52 | $90 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $25 | $32 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $23 | $31 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $25 | $33 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $23 | $31 | $47 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $27 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $28 | $54 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $3 | $11 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $19 | $35 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $50 | $218 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $249 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $99 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $17 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $72 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $62 | $97 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $162 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $119 | $174 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $225 | $239 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $88 | $88 | $88 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $31 | $81 | $115 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $79 | $119 | $175 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $104 | $134 | $182 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $40 | $120 | $205 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $113 | $129 | $146 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $97 | $158 | $229 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $73 | $156 | $249 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $26 | $111 | $155 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $91 | $143 | $179 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $133 | $165 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $75 | $105 | $129 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $159 | $185 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $94 | $130 | $190 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $165 | $205 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $34 | $62 | $94 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $19 | $222 | $425 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $472 | $814 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $239 | $612 | $814 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $91 | $142 | $204 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $255 | $351 | $399 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $213 | $312 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $41 | $294 | $568 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $299 | $528 | $655 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $219 | $408 | $585 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $29 | $375 | $799 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $403 | $606 | $996 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $839 | $1,873 | $2,864 |