| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $90 | $154 | $200 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $87 | $119 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $41 | $64 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $36 | $56 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $28 | $42 | $55 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $43 | $51 | $58 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $55 | $83 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $37 | $55 | $72 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $15 | $33 | $40 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $11 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $31 | $36 | $42 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $16 | $19 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $317 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $240 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $109 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $96 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $46 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $124 | $183 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $140 | $147 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $225 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $69 | $69 | $69 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $101 | $154 | $186 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $87 | $127 | $194 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $189 | $210 | $238 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $113 | $133 | $158 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $158 | $196 | $223 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $204 | $248 | $301 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $202 | $269 | $327 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $127 | $160 | $197 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $86 | $157 | $207 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $116 | $165 | $206 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $133 | $185 | $226 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $83 | $166 | $231 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $161 | $213 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $213 | $248 | $268 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $47 | $63 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $59 | $186 | $298 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $184 | $228 | $302 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $302 | $310 | $317 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $265 | $265 | $265 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $265 | $294 | $323 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $208 | $231 | $254 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $395 | $450 | $493 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $437 | $437 | $438 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $213 | $400 | $513 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $556 | $556 | $556 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $377 | $521 | $594 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,461 | $1,979 | $2,483 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $129 | $143 | $157 |