| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $80 | $93 | $115 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $97 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $63 | $79 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $36 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $47 | $63 | $77 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $34 | $53 | $63 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $50 | $74 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $44 | $48 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $33 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $11 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $14 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $27 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $214 | $271 | $328 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $292 | $384 | $560 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $66 | $103 | $119 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $25 | $33 | $41 |
| MMR vaccine CPT 90707 • Preventive Care | $82 | $94 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $32 | $55 | $93 |
| Varicella vaccine CPT 90716 • Preventive Care | $82 | $137 | $205 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $65 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $292 | $468 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $77 | $77 | $77 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $77 | $111 | $150 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $88 | $118 | $155 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $138 | $205 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $202 | $244 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $225 | $231 | $236 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $190 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $145 | $217 | $290 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $133 | $134 | $135 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $151 | $208 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $133 | $154 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $114 | $159 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $124 | $178 | $232 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $97 | $130 | $170 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $102 | $157 | $238 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $52 | $65 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $77 | $148 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $252 | $304 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $258 | $426 | $594 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $216 | $322 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $209 | $302 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $104 | $128 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $115 | $183 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $218 | $218 | $218 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $187 | $344 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $287 | $617 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $388 | $633 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $223 | $1,124 | $2,012 |