| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $35 | $129 | $223 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $70 | $121 | $223 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $49 | $101 | $154 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $44 | $82 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $40 | $73 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $38 | $71 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $40 | $75 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $58 | $106 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $50 | $92 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $24 | $53 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $13 | $30 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $32 | $53 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $14 | $30 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $198 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $86 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $17 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $83 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $43 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $135 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $126 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $103 | $103 | $103 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $14 | $118 | $247 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $49 | $109 | $180 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $15 | $102 | $191 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $115 | $226 | $302 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $17 | $140 | $293 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $13 | $124 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $16 | $174 | $368 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $58 | $158 | $222 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $10 | $112 | $237 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $64 | $169 | $236 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $72 | $165 | $258 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $11 | $169 | $264 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $53 | $124 | $213 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $13 | $158 | $303 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $5 | $57 | $130 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $39 | $122 | $206 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $128 | $693 | $1,257 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $128 | $693 | $1,258 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $157 | $230 | $377 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $156 | $230 | $377 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $122 | $180 | $294 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $24 | $398 | $926 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $13 | $258 | $492 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $131 | $405 | $954 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $76 | $333 | $581 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $35 | $346 | $657 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $216 | $757 | $1,230 |