| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $107 | $152 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $84 | $107 | $152 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $32 | $65 | $105 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $20 | $38 | $56 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $37 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $17 | $33 | $48 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $38 | $51 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $22 | $47 | $72 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $41 | $63 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $23 | $30 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $17 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $19 | $30 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $27 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $302 | $358 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $247 | $281 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $102 | $111 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $103 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $45 | $54 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $167 | $209 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $128 | $131 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $181 | $235 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $81 | $81 | $81 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $43 | $134 | $198 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $64 | $128 | $169 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $9 | $134 | $216 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $11 | $128 | $245 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $175 | $237 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $18 | $153 | $222 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $13 | $184 | $299 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $28 | $117 | $179 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $135 | $190 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $41 | $129 | $190 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $163 | $209 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $86 | $158 | $214 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $94 | $169 | $228 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $160 | $187 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $28 | $50 | $79 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $44 | $211 | $386 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $32 | $228 | $423 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $98 | $227 | $425 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $164 | $192 | $230 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $212 | $304 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $114 | $154 | $205 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $18 | $352 | $540 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $46 | $399 | $601 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $33 | $154 | $309 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $45 | $504 | $767 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $301 | $558 | $816 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $147 | $1,055 | $2,506 |