| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $48 | $60 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $49 | $55 | $60 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $17 | $36 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $43 | $65 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $17 | $20 | $24 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $19 | $23 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $26 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $27 | $44 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $25 | $41 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $12 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $17 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $4 | $8 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $18 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $270 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $59 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $25 | $32 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $54 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $52 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $141 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $88 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $194 | $244 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $67 | $67 | $67 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $99 | $136 | $181 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $64 | $122 | $190 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $161 | $198 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $104 | $135 | $169 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $179 | $216 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $135 | $212 | $251 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $146 | $230 | $272 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $125 | $193 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $151 | $163 | $175 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $109 | $151 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $75 | $79 | $83 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $8 | $145 | $231 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $7 | $135 | $208 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $157 | $202 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $45 | $56 | $63 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $7 | $33 | $58 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $18 | $134 | $334 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $35 | $154 | $251 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $210 | $267 | $319 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $128 | $230 | $281 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $91 | $133 | $190 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $12 | $131 | $250 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $93 | $183 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $12 | $81 | $190 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $201 | $230 | $259 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $40 | $190 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $152 | $192 | $232 |