| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $71 | $102 | $157 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $78 | $81 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $49 | $53 | $57 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $29 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $28 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $25 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $27 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $38 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $32 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $16 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $20 | $26 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $301 | $386 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $99 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $28 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $69 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $53 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $183 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $90 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $126 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $44 | $44 | $44 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $74 | $107 | $172 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $134 | $180 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $85 | $129 | $187 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $158 | $210 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $96 | $150 | $204 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $136 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $160 | $208 | $256 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $96 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $62 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $102 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $88 | $136 | $184 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $95 | $138 | $196 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $20 | $110 | $211 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $38 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $56 | $141 | $185 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $92 | $265 | $364 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $145 | $255 | $364 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $161 | $228 | $261 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $165 | $168 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $112 | $124 | $131 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $294 | $294 | $295 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $320 | $323 | $326 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $167 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $204 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $32 | $202 | $403 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $865 | $1,273 | $1,477 |