| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $63 | $82 | $156 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $78 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $42 | $47 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $31 | $55 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $25 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $27 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $28 | $30 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $27 | $33 | $43 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $35 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $251 | $288 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $231 | $257 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $99 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $92 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $27 | $36 | $47 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $174 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $111 | $123 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $190 | $213 | $239 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $47 | $47 | $47 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $94 | $101 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $105 | $118 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $104 | $123 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $105 | $116 | $140 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $109 | $127 | $161 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $118 | $133 | $157 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $146 | $154 | $170 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $73 | $84 | $91 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $82 | $95 | $109 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $79 | $86 | $91 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $70 | $93 | $119 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $98 | $105 | $122 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $88 | $122 | $191 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $88 | $127 | $190 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $33 | $41 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $180 | $182 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $52 | $151 | $193 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $180 | $285 | $340 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $125 | $126 | $129 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $136 | $145 | $173 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $92 | $114 | $169 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $199 | $263 | $310 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $269 | $335 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $141 | $208 | $312 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $162 | $291 | $334 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $38 | $221 | $393 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $230 | $615 | $932 |