| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $84 | $92 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $84 | $92 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $57 | $63 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $37 | $42 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $31 | $37 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $31 | $36 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $30 | $37 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $52 | $52 | $52 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $40 | $45 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $28 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $271 | $287 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $42 | $82 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $35 | $82 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $45 | $54 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $145 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $25 | $102 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $173 | $192 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $55 | $136 | $253 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $55 | $142 | $265 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $60 | $158 | $276 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $70 | $168 | $302 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $129 | $168 | $206 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $125 | $217 | $324 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $218 | $271 | $324 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $132 | $180 | $228 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $50 | $145 | $243 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $50 | $106 | $179 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $60 | $156 | $266 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $147 | $209 | $271 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $115 | $174 | $290 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $212 | $324 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $64 | $91 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $184 | $295 | $406 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $449 | $775 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $341 | $447 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $228 | $293 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $227 | $388 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $164 | $262 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $340 | $569 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $322 | $386 | $419 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $297 | $592 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $417 | $808 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $350 | $859 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,278 | $1,914 | $2,550 |