| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $92 | $166 | $241 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $113 | $165 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $40 | $59 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $56 | $79 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $30 | $53 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $32 | $32 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $36 | $36 | $36 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $32 | $32 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $27 | $36 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $19 | $31 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $33 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $15 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $313 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $453 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $88 | $105 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $38 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $62 | $73 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $53 | $57 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $107 | $141 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $45 | $89 | $134 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $196 | $220 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $115 | $115 | $115 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $123 | $181 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $133 | $197 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $123 | $166 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $152 | $191 | $215 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $193 | $272 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $209 | $253 | $316 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $343 | $358 | $373 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $81 | $99 | $127 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $73 | $122 | $164 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $83 | $106 | $145 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $125 | $183 | $240 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $89 | $112 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $93 | $172 | $262 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $152 | $194 | $281 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $59 | $85 | $110 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $285 | $383 | $481 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $169 | $320 | $606 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $171 | $388 | $606 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $253 | $260 | $264 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $168 | $199 | $231 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $197 | $211 | $225 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $391 | $557 | $675 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $240 | $460 | $680 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $38 | $191 | $452 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $554 | $711 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $311 | $355 | $399 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,570 | $2,376 | $3,182 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $97 | $97 | $97 |