| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $40 | $51 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $28 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $26 | $28 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $25 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $21 | $25 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $22 | $33 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $30 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $17 | $27 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $13 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $10 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $318 | $375 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $96 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $96 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $44 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $157 | $219 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $99 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $94 | $188 | $268 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $36 | $36 | $36 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $54 | $100 | $117 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $110 | $127 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $88 | $113 | $124 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $70 | $118 | $135 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $70 | $116 | $135 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $113 | $143 | $159 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $124 | $153 | $172 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $88 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $76 | $100 | $115 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $76 | $98 | $114 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $107 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $62 | $99 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $92 | $116 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $103 | $127 | $135 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $38 | $42 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $134 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $293 | $424 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $322 | $424 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $106 | $143 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $160 | $188 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $119 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $217 | $303 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $273 | $294 | $344 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $195 | $312 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $279 | $380 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $258 | $406 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $823 | $1,139 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $81 | $90 | $98 |
| Spirometry CPT 94010 • Pulmonology | $7 | $23 | $30 |