| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $101 | $136 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $82 | $94 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $39 | $49 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $38 | $44 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $32 | $43 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $33 | $46 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $38 | $54 | $64 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $37 | $37 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $20 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $11 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $24 | $27 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $18 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $250 | $289 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $93 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $94 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $50 | $54 |
| Varicella vaccine CPT 90716 • Preventive Care | $124 | $158 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $140 | $188 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $196 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $103 | $126 | $149 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $136 | $146 | $156 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $120 | $130 | $140 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $150 | $167 | $185 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $100 | $140 | $179 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $144 | $176 | $208 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $177 | $177 | $177 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $80 | $89 | $97 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $106 | $106 | $107 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $85 | $95 | $106 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $120 | $129 | $138 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $124 | $143 | $162 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $134 | $137 | $140 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $150 | $167 | $185 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $53 | $53 | $53 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $233 | $233 | $233 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $207 | $325 | $444 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $240 | $342 | $445 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $223 | $223 | $224 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $186 | $218 | $229 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $151 | $175 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $326 | $329 | $330 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $65 | $303 | $363 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $201 | $339 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $152 | $391 | $462 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $180 | $335 | $491 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $308 | $1,291 | $1,623 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $116 | $127 |