| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $101 | $117 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $99 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $72 | $97 | $122 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $54 | $63 | $77 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $32 | $48 | $65 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $28 | $51 | $63 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $34 | $45 | $56 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $60 | $85 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $43 | $56 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $12 | $36 | $59 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $16 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $16 | $23 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $304 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $313 | $382 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $109 | $116 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $36 | $49 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $106 | $112 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $59 | $93 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $196 | $205 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $116 | $166 | $254 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $266 | $468 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $58 | $58 | $58 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $92 | $135 | $165 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $132 | $169 | $225 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $61 | $134 | $172 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $126 | $169 | $209 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $99 | $143 | $187 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $127 | $182 | $238 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $175 | $220 | $250 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $84 | $106 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $98 | $130 | $151 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $66 | $109 | $150 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $84 | $124 | $160 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $83 | $142 | $232 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $166 | $191 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $96 | $146 | $183 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $37 | $45 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $493 | $493 | $493 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $200 | $342 | $515 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $107 | $265 | $430 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $194 | $237 | $322 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $184 | $194 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $141 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $183 | $347 | $632 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $417 | $453 | $490 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $156 | $237 | $390 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $219 | $428 | $569 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $36 | $311 | $823 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $310 | $1,151 | $1,953 |