| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $83 | $130 | $191 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $106 | $108 | $110 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $72 | $91 | $128 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $39 | $57 | $82 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $29 | $31 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $29 | $31 | $35 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $30 | $36 | $43 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $53 | $53 | $53 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $38 | $39 | $41 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $25 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $31 | $59 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $16 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $264 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $283 | $339 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $88 | $99 | $110 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $65 | $83 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $43 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $114 | $160 | $207 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $73 | $120 | $174 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $193 | $233 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $81 | $81 | $81 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $110 | $149 | $258 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $115 | $151 | $197 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $90 | $135 | $205 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $104 | $189 | $317 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $102 | $132 | $163 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $161 | $198 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $163 | $181 | $204 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $66 | $81 | $105 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $112 | $145 | $181 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $79 | $130 | $180 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $119 | $146 | $198 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $106 | $177 | $277 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $125 | $165 | $216 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $144 | $207 | $318 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $50 | $65 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $245 | $245 | $245 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $211 | $306 | $536 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $364 | $492 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $125 | $227 | $391 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $210 | $248 | $293 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $116 | $141 | $198 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $167 | $331 | $563 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $174 | $234 | $294 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $170 | $270 | $474 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $375 | $479 | $564 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $112 | $365 | $600 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $250 | $827 | $1,394 |