| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $58 | $82 | $110 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $99 | $110 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $40 | $76 | $140 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $21 | $35 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $30 | $55 | $67 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $28 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $31 | $57 | $70 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $14 | $24 | $43 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $36 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $35 | $51 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $16 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $11 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $333 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $101 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $19 | $79 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $43 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $154 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $99 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $94 | $187 | $220 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $88 | $184 | $234 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $182 | $244 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $100 | $181 | $254 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $73 | $151 | $283 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $107 | $177 | $275 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $202 | $317 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $188 | $292 | $344 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $92 | $138 | $211 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $57 | $123 | $224 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $138 | $223 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $65 | $138 | $244 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $103 | $176 | $248 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $73 | $150 | $263 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $82 | $150 | $284 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $52 | $81 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $184 | $189 | $194 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $128 | $345 | $679 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $213 | $561 | $790 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $265 | $356 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $266 | $355 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $180 | $281 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $370 | $589 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $302 | $302 | $302 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $126 | $402 | $599 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $457 | $808 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $77 | $358 | $857 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $256 | $1,848 | $2,928 |