| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $71 | $117 | $245 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $71 | $75 | $80 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $120 | $245 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $54 | $57 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $20 | $42 | $90 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $38 | $80 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $22 | $26 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $23 | $26 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $20 | $68 | $117 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $21 | $25 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $23 | $35 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $13 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $22 | $52 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $13 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $333 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $294 | $331 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $102 | $110 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $22 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $103 | $112 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $45 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $191 | $207 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $123 | $126 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $207 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $53 | $102 | $128 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $92 | $120 | $133 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $132 | $162 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $69 | $117 | $156 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $151 | $250 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $157 | $187 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $189 | $215 | $239 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $87 | $115 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $88 | $110 | $202 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $73 | $93 | $122 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $61 | $110 | $134 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $100 | $122 | $168 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $110 | $147 | $239 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $12 | $113 | $174 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $36 | $72 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $65 | $66 | $66 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $339 | $477 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $219 | $235 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $130 | $206 | $321 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $179 | $293 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $162 | $250 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $274 | $452 | $642 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $96 | $403 | $711 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $209 | $375 | $661 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $229 | $306 | $383 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $252 | $455 |