| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $56 | $65 | $80 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $61 | $70 | $78 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $19 | $33 | $47 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $28 | $29 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $26 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $25 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $21 | $24 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $34 | $38 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $32 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $10 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $9 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $55 | $233 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $269 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $46 | $84 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $23 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $79 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $41 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $184 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $95 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $42 | $129 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $39 | $39 | $39 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $11 | $74 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $11 | $67 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $13 | $71 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $10 | $91 | $132 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $44 | $87 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $17 | $88 | $147 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $19 | $97 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $65 | $85 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $7 | $52 | $75 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $70 | $73 | $77 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $14 | $47 | $80 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $17 | $70 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $47 | $85 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $37 | $65 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $38 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $10 | $77 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $88 | $130 | $180 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $32 | $130 | $227 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $111 | $146 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $110 | $142 | $166 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $112 | $119 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $129 | $180 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $185 | $221 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $38 | $105 | $173 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $41 | $209 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $38 | $219 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $192 | $568 | $1,278 |