| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $125 | $170 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $98 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $32 | $56 | $82 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $52 | $73 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $28 | $32 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $31 | $51 | $69 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $38 | $61 | $89 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $34 | $34 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $48 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $21 | $26 |
| Immunization admin injection single CPT 90471 • Preventive Care | $22 | $47 | $59 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $16 | $23 | $26 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $228 | $292 | $434 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $339 | $377 | $414 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $101 | $135 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $33 | $41 |
| MMR vaccine CPT 90707 • Preventive Care | $65 | $84 | $128 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $60 | $68 |
| Varicella vaccine CPT 90716 • Preventive Care | $114 | $145 | $253 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $182 | $238 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $207 | $284 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $81 | $81 | $81 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $103 | $205 | $258 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $136 | $205 | $240 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $140 | $213 | $251 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $140 | $228 | $317 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $100 | $222 | $273 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $144 | $246 | $318 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $239 | $309 | $345 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $80 | $150 | $206 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $107 | $176 | $247 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $85 | $157 | $220 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $138 | $189 | $241 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $124 | $200 | $247 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $140 | $223 | $263 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $150 | $192 | $283 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $62 | $80 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $304 | $304 | $304 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $68 | $431 | $734 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $240 | $626 | $871 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $301 | $347 | $391 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $186 | $301 | $358 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $146 | $213 | $271 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $340 | $476 | $563 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $65 | $517 | $740 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $44 | $325 | $697 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $152 | $372 | $564 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $64 | $427 | $846 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,394 | $1,705 | $2,022 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $182 | $182 | $182 |