| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $74 | $113 | $139 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $74 | $104 | $132 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $50 | $79 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $32 | $55 | $82 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $32 | $57 | $82 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $28 | $30 | $31 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $31 | $51 | $77 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $38 | $42 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $31 | $35 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $40 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $18 | $30 |
| Immunization admin injection single CPT 90471 • Preventive Care | $15 | $28 | $59 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $20 | $30 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $291 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $354 | $464 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $88 | $98 | $109 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $34 | $46 |
| MMR vaccine CPT 90707 • Preventive Care | $65 | $77 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $55 | $76 |
| Varicella vaccine CPT 90716 • Preventive Care | $114 | $140 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $116 | $161 | $238 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $192 | $220 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $43 | $43 | $43 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $72 | $176 | $258 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $108 | $180 | $270 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $112 | $187 | $282 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $126 | $232 | $317 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $123 | $189 | $307 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $142 | $178 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $154 | $249 | $387 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $65 | $94 | $124 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $98 | $125 | $182 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $72 | $114 | $180 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $81 | $131 | $198 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $110 | $140 | $163 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $91 | $182 | $295 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $126 | $165 | $199 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $64 | $90 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $45 | $89 | $134 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $143 | $196 | $236 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $209 | $209 | $209 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $150 | $310 | $391 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $159 | $285 | $402 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $174 | $271 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $300 | $475 | $563 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $319 | $475 | $632 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $44 | $145 | $225 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $323 | $468 | $564 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $55 | $117 | $183 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $282 | $1,102 | $1,911 |