| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $70 | $76 | $81 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $70 | $107 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $27 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $27 | $31 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $25 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $26 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $28 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $26 | $29 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $24 | $32 | $47 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $18 | $29 | $42 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $17 | $30 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $302 | $369 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $254 | $355 | $555 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $122 | $147 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $5 | $14 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $118 | $149 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $53 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $223 | $261 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $178 | $287 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $252 | $299 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $59 | $59 | $59 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $5 | $130 | $223 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $5 | $110 | $233 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $95 | $157 | $242 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $104 | $166 | $272 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $5 | $125 | $225 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $121 | $210 | $305 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $97 | $119 | $141 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $5 | $89 | $159 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $56 | $113 | $175 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $5 | $119 | $213 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $85 | $150 | $233 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $5 | $101 | $173 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $142 | $254 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $105 | $148 | $198 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $43 | $48 | $52 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $188 | $188 | $188 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $316 | $329 | $342 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $316 | $316 | $316 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $181 | $261 | $341 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $230 | $285 | $340 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $154 | $210 | $267 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $215 | $291 | $366 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $403 | $441 | $479 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $102 | $164 | $219 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $124 | $335 | $482 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $133 | $309 | $571 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $306 | $334 | $361 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $110 | $135 |