| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $144 | $200 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $36 | $82 | $133 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $28 | $45 | $77 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $37 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $32 | $48 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $34 | $42 | $50 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $54 | $72 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $37 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $25 | $46 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $23 | $33 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $19 | $22 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $319 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $254 | $275 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $71 | $93 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $13 | $18 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $68 | $86 | $110 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $35 | $47 | $62 |
| Varicella vaccine CPT 90716 • Preventive Care | $124 | $187 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $82 | $114 | $147 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $129 | $174 | $242 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $28 | $28 | $28 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $156 | $219 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $51 | $150 | $229 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $74 | $163 | $238 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $84 | $151 | $221 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $71 | $175 | $260 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $110 | $195 | $301 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $119 | $213 | $278 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $120 | $197 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $121 | $179 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $65 | $113 | $173 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $63 | $129 | $196 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $73 | $147 | $235 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $171 | $250 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $84 | $154 | $268 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $20 | $39 | $57 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $126 | $126 | $126 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $596 | $596 | $596 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $238 | $238 | $238 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $118 | $204 | $247 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $121 | $202 | $323 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $173 | $254 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $446 | $470 | $493 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $490 | $490 | $490 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $464 | $488 | $513 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $248 | $248 | $248 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $377 | $521 | $665 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $677 | $1,580 | $2,483 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $66 | $66 | $66 |