| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $81 | $91 | $115 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $117 | $136 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $55 | $63 | $80 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $46 | $55 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $37 | $47 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $41 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $36 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $31 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $27 | $29 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $19 | $26 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $12 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $1 | $18 | $27 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $16 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $197 | $324 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $306 | $364 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $18 | $90 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $4 | $28 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $92 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $55 | $70 |
| Varicella vaccine CPT 90716 • Preventive Care | $91 | $170 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $152 | $188 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $160 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $48 | $48 | $48 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $99 | $136 | $150 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $126 | $158 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $10 | $122 | $210 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $129 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $85 | $137 | $180 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $138 | $195 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $151 | $189 | $227 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $89 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $99 | $145 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $9 | $86 | $145 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $102 | $120 | $159 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $86 | $116 | $140 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $52 | $127 | $204 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $96 | $177 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $19 | $40 | $52 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $13 | $127 | $285 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $169 | $324 | $515 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $84 | $270 | $515 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $73 | $148 | $223 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $110 | $173 | $223 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $113 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $239 | $412 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $282 | $363 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $44 | $206 | $417 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $17 | $388 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $95 | $208 | $265 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $152 | $808 | $1,623 |