| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $84 | $110 | $136 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $80 | $94 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $40 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $30 | $37 | $44 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $27 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $31 | $31 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $41 | $41 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $37 | $37 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $29 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $24 | $28 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $16 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $276 | $346 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $298 | $364 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $97 | $107 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $96 | $102 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $52 | $57 | $65 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $173 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $146 | $188 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $216 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $128 | $143 | $152 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $93 | $119 | $153 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $140 | $165 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $131 | $178 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $173 | $184 | $199 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $187 | $226 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $177 | $197 | $217 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $116 | $135 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $98 | $125 | $156 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $111 | $145 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $108 | $158 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $115 | $130 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $153 | $191 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $179 | $183 | $190 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $48 | $53 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $233 | $233 | $233 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $321 | $444 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $256 | $353 | $449 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $195 | $214 | $223 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $205 | $229 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $144 | $169 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $199 | $296 | $330 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $275 | $363 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $192 | $259 | $339 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $349 | $524 | $699 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $265 | $329 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $332 | $1,433 | $2,500 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $127 | $127 | $127 |