| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $105 | $148 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $84 | $116 | $148 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $49 | $69 | $102 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $32 | $33 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $26 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $22 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $24 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $28 | $34 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $29 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $21 | $29 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $13 | $16 | $18 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $12 | $15 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $26 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $321 | $368 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $301 | $387 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $100 | $114 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $27 | $32 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $98 | $108 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $57 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $173 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $153 | $208 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $214 | $241 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $81 | $81 | $81 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $139 | $200 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $149 | $213 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $153 | $222 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $130 | $170 | $248 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $131 | $187 | $244 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $195 | $278 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $167 | $204 | $241 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $130 | $130 | $130 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $101 | $152 | $196 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $100 | $131 | $192 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $122 | $160 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $165 | $165 | $165 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $158 | $231 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $107 | $162 | $248 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $55 | $79 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $353 | $353 | $353 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $206 | $439 | $673 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $137 | $292 | $446 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $105 | $218 | $305 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $131 | $202 | $312 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $147 | $211 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $117 | $369 | $568 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $279 | $372 | $465 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $514 | $514 | $514 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $378 | $420 | $462 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $426 | $426 | $426 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $536 | $912 | $1,288 |