| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $66 | $122 | $156 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $66 | $109 | $144 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $45 | $67 | $98 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $41 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $39 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $29 | $44 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $37 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $42 | $51 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $34 | $41 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $24 | $43 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $13 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $34 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $17 | $19 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $344 | $369 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $276 | $322 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $110 | $117 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $28 | $28 | $28 |
| MMR vaccine CPT 90707 • Preventive Care | $105 | $111 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $62 | $66 | $70 |
| Varicella vaccine CPT 90716 • Preventive Care | $199 | $219 | $240 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $146 | $146 | $146 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $221 | $251 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $10 | $105 | $187 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $123 | $158 | $195 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $122 | $148 | $164 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $92 | $131 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $132 | $162 | $179 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $113 | $176 | $267 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $162 | $184 | $223 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $91 | $120 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $72 | $122 | $180 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $144 | $162 | $179 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $78 | $114 | $150 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $110 | $158 | $201 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $121 | $151 | $172 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $9 | $137 | $228 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $71 | $71 | $71 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $111 | $179 | $247 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $106 | $321 | $615 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $131 | $365 | $707 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $148 | $171 | $216 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $148 | $253 | $323 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $117 | $191 | $254 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $183 | $344 | $567 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $395 | $601 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $19 | $295 | $517 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $215 | $402 | $609 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $377 | $519 | $661 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $304 | $973 | $1,641 |