| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $70 | $77 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $70 | $75 | $80 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $53 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $27 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $25 | $26 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $24 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $24 | $26 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $26 | $28 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $27 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $20 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $11 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $11 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $360 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $254 | $261 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $104 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $5 | $16 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $82 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $49 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $163 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $95 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $221 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $5 | $66 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $92 | $103 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $91 | $105 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $72 | $114 | $154 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $99 | $102 | $104 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $134 | $152 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $5 | $65 | $125 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $78 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $59 | $82 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $56 | $88 | $120 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $64 | $91 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $5 | $85 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $92 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $5 | $80 | $116 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $5 | $19 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $143 | $163 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $231 | $268 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $231 | $233 | $235 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $126 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $152 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $113 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $168 | $254 | $352 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $387 | $395 | $403 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $66 | $199 | $359 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $192 | $313 | $399 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $250 | $455 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $306 | $891 | $1,278 |