| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $48 | $65 | $88 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $48 | $70 | $88 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $45 | $61 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $25 | $32 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $17 | $23 | $29 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $20 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $26 | $30 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $30 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $23 | $36 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $22 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $9 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $20 | $21 | $26 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $15 | $19 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $299 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $70 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $80 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $42 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $132 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $88 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $146 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $37 | $37 | $37 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $75 | $116 | $166 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $121 | $166 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $82 | $124 | $172 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $89 | $119 | $193 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $129 | $158 | $188 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $104 | $150 | $217 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $179 | $179 | $179 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $94 | $142 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $35 | $115 | $159 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $50 | $83 | $107 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $77 | $98 | $122 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $58 | $114 | $170 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $127 | $181 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $14 | $91 | $143 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $30 | $58 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $103 | $179 | $256 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $88 | $179 | $264 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $104 | $259 | $476 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $154 | $243 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $162 | $242 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $90 | $118 | $190 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $247 | $298 | $350 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $186 | $186 | $186 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $25 | $87 | $189 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $72 | $147 | $221 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $120 | $258 | $515 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $312 | $462 | $762 |