| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $122 | $190 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $182 | $186 | $190 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $38 | $75 | $94 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $49 | $58 | $67 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $34 | $44 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $34 | $58 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $61 | $64 | $66 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $32 | $40 | $48 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $50 | $75 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $32 | $33 | $34 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $27 | $35 | $45 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $351 | $351 | $351 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $299 | $364 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $141 | $207 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $35 | $37 | $39 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $155 | $198 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $54 | $57 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $251 | $387 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $136 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $319 | $418 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $103 | $103 | $103 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $67 | $118 | $146 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $109 | $124 | $153 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $77 | $117 | $159 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $87 | $174 | $263 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $173 | $205 | $237 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $241 | $296 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $151 | $184 | $217 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $118 | $156 | $193 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $83 | $95 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $96 | $113 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $107 | $125 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $206 | $218 | $231 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $112 | $134 | $166 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $150 | $173 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $42 | $52 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $67 | $67 | $67 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $122 | $277 | $530 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $122 | $326 | $530 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $177 | $203 | $223 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $189 | $223 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $123 | $126 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $330 | $386 | $426 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $336 | $350 | $363 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $252 | $452 | $739 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $349 | $516 | $774 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $371 | $434 | $474 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,278 | $1,403 | $1,623 |