| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $83 | $84 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $61 | $69 | $84 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $51 | $63 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $31 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $16 | $26 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $28 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $24 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $23 | $32 | $48 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $37 | $41 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $14 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $9 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $8 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $137 | $287 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $267 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $18 | $81 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $59 | $90 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $41 | $50 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $82 | $151 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $69 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $42 | $172 | $258 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $37 | $37 | $37 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $53 | $77 | $92 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $48 | $78 | $96 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $69 | $87 | $101 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $10 | $78 | $114 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $11 | $74 | $110 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $13 | $70 | $128 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $20 | $85 | $127 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $12 | $50 | $83 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $82 | $85 | $89 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $10 | $53 | $88 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $65 | $77 | $97 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $99 | $112 | $125 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $12 | $72 | $106 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $97 | $114 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $14 | $23 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $143 | $164 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $35 | $142 | $273 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $59 | $160 | $274 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $86 | $120 | $138 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $147 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $103 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $28 | $161 | $256 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $107 | $206 | $289 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $22 | $115 | $209 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $41 | $232 | $369 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $56 | $103 | $151 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $43 | $538 | $1,381 |