| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $67 | $129 | $235 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $66 | $128 | $235 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $44 | $65 | $94 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $34 | $49 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $18 | $32 | $44 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $23 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $23 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $32 | $49 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $26 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $21 | $31 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $20 | $27 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $14 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $327 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $293 | $364 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $104 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $23 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $100 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $51 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $193 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $152 | $188 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $230 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $143 | $143 | $143 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $72 | $143 | $271 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $77 | $151 | $282 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $82 | $164 | $294 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $100 | $183 | $332 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $100 | $179 | $322 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $123 | $206 | $371 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $115 | $217 | $403 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $134 | $244 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $68 | $137 | $260 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $78 | $143 | $259 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $152 | $283 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $84 | $155 | $289 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $100 | $184 | $362 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $112 | $178 | $332 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $29 | $52 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $53 | $119 | $200 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $295 | $369 | $449 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $197 | $360 | $449 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $182 | $223 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $204 | $233 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $104 | $136 | $175 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $186 | $397 | $789 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $121 | $279 | $363 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $190 | $402 | $784 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $195 | $465 | $988 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $170 | $505 | $1,113 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $201 | $1,291 | $2,746 |