| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $23 | $51 | $78 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $47 | $63 | $78 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $31 | $39 | $53 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $19 | $24 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $24 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $17 | $21 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $18 | $23 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $21 | $27 | $37 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $18 | $23 | $32 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $16 | $28 | $37 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $15 | $18 |
| Immunization admin injection single CPT 90471 • Preventive Care | $16 | $25 | $35 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $17 | $23 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $308 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $313 | $413 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $91 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $4 | $17 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $72 | $97 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $40 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $225 | $261 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $101 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $249 | $299 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $65 | $65 | $65 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $13 | $70 | $112 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $157 | $233 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $7 | $116 | $193 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $158 | $190 | $210 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $102 | $144 | $179 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $218 | $227 | $236 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $129 | $215 | $331 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $6 | $100 | $154 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $118 | $157 | $214 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $112 | $146 | $163 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $68 | $137 | $179 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $130 | $151 | $176 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $98 | $169 | $202 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $158 | $190 | $211 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $28 | $35 | $40 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $59 | $146 | $214 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $48 | $331 | $615 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $144 | $301 | $615 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $126 | $175 | $235 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $168 | $224 | $261 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $161 | $232 | $267 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $156 | $286 | $493 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $174 | $309 | $522 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $90 | $151 | $243 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $104 | $305 | $530 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $15 | $306 | $597 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $351 | $827 | $1,427 |