| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $63 | $85 | $115 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $63 | $85 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $43 | $88 | $169 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $34 | $43 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $35 | $47 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $24 | $29 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $35 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $76 | $116 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $32 | $42 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $13 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $16 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $16 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $336 | $344 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $231 | $232 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $111 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $23 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $62 | $85 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $53 | $60 | $70 |
| Varicella vaccine CPT 90716 • Preventive Care | $107 | $168 | $205 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $141 | $164 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $194 | $212 | $221 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $48 | $48 | $48 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $109 | $128 | $150 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $114 | $137 | $158 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $130 | $144 | $164 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $161 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $147 | $180 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $127 | $237 | $316 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $191 | $234 | $289 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $119 | $143 | $174 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $115 | $143 | $185 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $130 | $153 | $184 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $111 | $156 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $94 | $155 | $207 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $93 | $121 | $136 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $97 | $170 | $237 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $51 | $67 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $98 | $116 | $133 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $207 | $355 | $580 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $93 | $256 | $417 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $141 | $148 | $162 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $154 | $192 | $229 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $104 | $164 | $236 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $183 | $273 | $334 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $181 | $245 | $309 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $188 | $250 | $321 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $219 | $323 | $442 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $123 | $325 | $642 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $152 | $988 | $1,946 |