| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $49 | $139 | $500 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $49 | $77 | $105 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $49 | $77 | $105 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $56 | $95 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $28 | $37 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $28 | $38 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $25 | $35 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $27 | $38 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $29 | $35 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $26 | $32 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $29 | $50 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $45 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $17 | $32 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $381 | $557 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $300 | $490 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $106 | $118 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $24 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $113 | $166 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $51 | $76 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $223 | $325 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $149 | $254 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $253 | $365 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $45 | $45 | $45 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $68 | $111 | $172 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $79 | $112 | $179 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $77 | $116 | $137 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $100 | $158 | $285 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $125 | $162 | $277 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $117 | $180 | $318 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $126 | $190 | $346 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $103 | $154 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $68 | $104 | $164 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $122 | $222 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $85 | $109 | $138 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $88 | $131 | $250 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $154 | $266 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $100 | $131 | $171 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $35 | $85 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $53 | $96 | $140 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $169 | $317 | $476 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $169 | $271 | $372 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $90 | $159 | $252 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $161 | $203 | $351 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $146 | $278 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $148 | $353 | $546 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $175 | $376 | $592 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $315 | $391 | $553 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $173 | $383 | $749 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $109 | $440 | $793 |