| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $61 | $80 | $117 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $61 | $84 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $42 | $55 | $79 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $44 | $77 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $20 | $41 | $65 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $50 | $68 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $30 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $34 | $43 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $42 | $74 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $14 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $11 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $15 | $27 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $79 | $371 | $668 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $374 | $560 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $12 | $86 | $116 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $8 | $24 | $41 |
| MMR vaccine CPT 90707 • Preventive Care | $12 | $108 | $207 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $51 | $75 | $96 |
| Varicella vaccine CPT 90716 • Preventive Care | $205 | $217 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $21 | $94 | $140 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $141 | $216 | $258 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $77 | $77 | $77 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $61 | $129 | $178 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $95 | $135 | $201 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $7 | $103 | $210 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $56 | $123 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $78 | $158 | $214 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $95 | $182 | $299 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $20 | $143 | $290 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $6 | $65 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $6 | $83 | $145 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $9 | $92 | $154 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $67 | $97 | $156 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $49 | $129 | $232 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $153 | $247 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $8 | $124 | $238 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $18 | $55 | $93 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $36 | $69 | $135 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $233 | $260 | $294 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $175 | $615 | $1,413 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $109 | $180 | $322 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $109 | $125 | $157 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $137 | $222 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $141 | $180 | $216 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $48 | $145 | $241 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $188 | $236 | $294 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $137 | $175 | $219 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $123 | $197 | $325 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $119 | $1,041 | $1,953 |