| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $29 | $52 | $74 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $29 | $56 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $20 | $35 | $50 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $26 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $14 | $24 | $33 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $14 | $22 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $14 | $22 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $14 | $25 | $35 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $28 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $23 | $25 | $27 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $13 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $13 | $23 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $8 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $277 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $21 | $61 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $59 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $27 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $39 | $115 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $106 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $157 | $219 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $43 | $43 | $43 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $9 | $40 | $72 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $65 | $89 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $10 | $61 | $112 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $16 | $71 | $126 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $11 | $67 | $123 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $9 | $76 | $142 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $15 | $88 | $162 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $12 | $52 | $97 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $72 | $79 | $86 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $56 | $82 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $10 | $45 | $81 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $47 | $65 | $83 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $36 | $80 | $124 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $82 | $104 | $126 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $17 | $27 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $55 | $57 | $61 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $142 | $176 | $209 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $95 | $199 | $312 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $109 | $130 | $150 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $143 | $151 | $167 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $97 | $102 | $113 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $41 | $170 | $300 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $133 | $147 | $161 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $98 | $116 | $134 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $48 | $188 | $327 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $34 | $198 | $377 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $160 | $490 | $820 |