| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $51 | $125 | $241 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $51 | $125 | $241 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $17 | $36 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $29 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $44 | $79 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $43 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $31 | $37 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $28 | $34 | $46 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $32 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $21 | $29 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $10 | $20 | $31 |
| Immunization admin injection single CPT 90471 • Preventive Care | $3 | $25 | $40 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $19 | $31 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $245 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $379 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $56 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $23 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $68 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $47 | $96 |
| Varicella vaccine CPT 90716 • Preventive Care | $29 | $127 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $158 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $158 | $219 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $66 | $66 | $66 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $31 | $131 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $10 | $143 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $172 | $270 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $81 | $147 | $212 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $175 | $298 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $175 | $238 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $10 | $190 | $373 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $12 | $70 | $143 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $83 | $113 | $153 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $6 | $106 | $155 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $69 | $119 | $169 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $14 | $128 | $201 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $182 | $287 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $11 | $156 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $11 | $37 | $59 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $33 | $119 | $240 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $120 | $198 | $276 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $30 | $211 | $454 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $97 | $197 | $253 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $181 | $248 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $88 | $128 | $168 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $31 | $277 | $606 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $23 | $301 | $680 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $60 | $296 | $628 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $45 | $463 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $302 | $405 | $508 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $525 | $1,630 | $3,182 |