| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $65 | $91 | $117 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $58 | $85 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $40 | $60 | $79 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $36 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $35 | $49 | $65 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $61 | $64 | $68 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $32 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $14 | $30 | $47 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $35 | $48 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $12 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $23 | $54 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $15 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $344 | $506 | $668 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $292 | $384 | $560 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $110 | $115 | $119 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $30 | $41 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $78 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $71 | $93 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $195 | $199 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $100 | $100 | $100 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $303 | $468 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $77 | $77 | $77 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $103 | $113 | $125 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $72 | $137 | $201 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $106 | $135 | $164 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $126 | $144 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $100 | $139 | $177 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $143 | $205 | $267 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $119 | $171 | $223 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $86 | $110 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $6 | $87 | $142 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $64 | $114 | $181 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $117 | $138 | $159 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $74 | $114 | $163 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $118 | $127 | $135 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $60 | $161 | $238 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $31 | $31 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $153 | $153 | $153 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $88 | $199 | $257 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $64 | $578 | $1,413 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $155 | $159 | $168 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $172 | $252 | $332 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $114 | $128 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $38 | $109 | $183 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $38 | $78 | $118 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $188 | $206 | $224 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $38 | $200 | $343 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $123 | $140 | $157 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $304 | $1,791 | $2,893 |