| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $42 | $70 | $83 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $80 | $84 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $29 | $48 | $57 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $30 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $28 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $28 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $25 | $28 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $39 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $17 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $1 | $19 | $31 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $10 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $269 | $291 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $46 | $85 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $16 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $19 | $75 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $40 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $82 | $155 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $27 | $92 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $94 | $184 | $242 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $107 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $8 | $86 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $83 | $101 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $50 | $98 | $132 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $64 | $132 | $211 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $17 | $102 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $80 | $121 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $34 | $64 | $91 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $83 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $10 | $79 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $11 | $79 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $94 | $115 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $47 | $113 | $189 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $116 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $27 | $34 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $28 | $123 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $36 | $154 | $235 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $90 | $214 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $124 | $150 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $156 | $166 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $117 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $49 | $195 | $294 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $26 | $148 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $50 | $150 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $15 | $177 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $236 | $403 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $217 | $668 | $1,278 |