| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $63 | $119 | $219 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $219 | $241 | $263 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $130 | $189 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $51 | $76 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $51 | $78 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $72 | $92 | $112 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $51 | $75 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $14 | $40 | $66 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $64 | $100 | $135 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $28 | $65 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $19 | $33 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $31 | $63 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $336 | $365 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $190 | $217 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $111 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $74 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $50 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $91 | $137 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $136 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $143 | $215 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $92 | $92 | $92 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $97 | $153 | $264 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $105 | $133 | $189 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $104 | $163 | $279 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $79 | $165 | $303 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $113 | $208 | $303 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $196 | $357 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $146 | $216 | $286 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $127 | $201 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $84 | $134 | $225 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $62 | $125 | $223 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $92 | $146 | $246 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $93 | $141 | $189 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $80 | $154 | $275 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $88 | $160 | $304 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $41 | $62 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $307 | $307 | $307 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $52 | $395 | $954 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $46 | $500 | $954 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $73 | $131 | $247 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $241 | $458 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $87 | $162 | $306 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $310 | $434 | $682 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $384 | $394 | $404 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $38 | $351 | $702 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $334 | $530 | $855 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $393 | $493 | $566 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $932 | $1,432 | $2,432 |