| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $60 | $66 | $78 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $60 | $66 | $78 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $41 | $47 | $53 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $24 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $14 | $24 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $14 | $22 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $26 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $14 | $26 | $37 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $26 | $32 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $24 | $24 | $25 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $12 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $12 | $25 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $8 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $238 | $308 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $85 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $95 | $99 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $43 | $49 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $133 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $168 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $46 | $46 | $46 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $26 | $62 | $82 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $9 | $61 | $89 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $45 | $74 | $89 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $10 | $70 | $105 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $14 | $71 | $101 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $12 | $83 | $154 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $9 | $88 | $132 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $4 | $52 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $12 | $59 | $107 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $8 | $44 | $79 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $13 | $51 | $89 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $42 | $81 | $120 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $34 | $84 | $128 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $75 | $106 | $138 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $19 | $28 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $10 | $57 | $97 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $42 | $216 | $391 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $28 | $209 | $391 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $103 | $124 | $166 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $113 | $133 | $172 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $76 | $89 | $115 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $41 | $204 | $314 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $56 | $222 | $332 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $41 | $98 | $155 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $41 | $218 | $337 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $33 | $91 | $199 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $78 | $586 | $908 |