| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $49 | $97 | $144 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $49 | $97 | $144 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $55 | $98 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $20 | $34 | $48 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $35 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $18 | $27 | $44 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $33 | $47 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $22 | $37 | $51 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $32 | $46 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $21 | $43 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $6 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $15 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $13 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $69 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $49 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $213 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $117 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $61 | $61 | $61 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $94 | $103 | $108 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $100 | $108 | $115 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $108 | $110 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $121 | $122 | $123 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $98 | $136 | $173 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $88 | $110 | $131 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $123 | $133 | $142 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $59 | $73 | $87 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $47 | $69 | $92 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $52 | $57 | $62 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $99 | $122 | $145 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $147 | $147 | $147 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $67 | $80 | $94 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $51 | $115 | $179 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $28 | $34 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $208 | $208 | $208 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $60 | $146 | $317 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $60 | $195 | $331 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $95 | $98 | $100 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $125 | $147 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $93 | $116 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $318 | $381 | $506 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $101 | $223 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $42 | $95 | $139 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $334 | $374 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $42 | $199 | $355 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $947 | $1,068 | $1,189 |