| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $110 | $181 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $49 | $74 | $87 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $34 | $53 | $65 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $33 | $40 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $25 | $35 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $18 | $23 | $34 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $38 | $61 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $54 | $86 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $27 | $42 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $19 | $36 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $12 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $304 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $229 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $80 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $16 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $94 | $98 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $42 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $160 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $99 | $137 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $193 | $245 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $49 | $49 | $49 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $54 | $100 | $136 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $36 | $111 | $202 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $17 | $96 | $154 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $40 | $123 | $182 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $10 | $108 | $231 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $17 | $157 | $268 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $62 | $159 | $291 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $30 | $102 | $174 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $7 | $82 | $136 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $14 | $119 | $185 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $90 | $146 | $203 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $89 | $123 | $159 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $88 | $156 | $222 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $95 | $136 | $182 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $25 | $44 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $104 | $180 | $331 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $60 | $251 | $632 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $60 | $251 | $633 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $76 | $133 | $223 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $167 | $296 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $115 | $200 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $159 | $314 | $464 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $151 | $253 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $65 | $337 | $483 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $131 | $401 | $659 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $65 | $370 | $700 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $190 | $525 | $947 |