| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $78 | $82 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $78 | $82 | $84 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $29 | $41 | $53 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $22 | $28 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $27 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $18 | $22 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $20 | $24 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $39 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $30 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $9 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $248 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $249 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $99 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $15 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $70 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $31 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $183 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $201 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $44 | $44 | $44 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $74 | $88 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $44 | $81 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $65 | $80 | $91 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $8 | $61 | $100 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $48 | $81 | $100 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $132 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $16 | $100 | $160 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $96 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $88 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $75 | $89 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $17 | $64 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $90 | $102 | $115 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $11 | $67 | $96 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $71 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $27 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $28 | $80 | $159 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $34 | $112 | $191 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $180 | $294 | $364 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $157 | $160 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $157 | $162 | $166 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $112 | $122 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $122 | $218 | $294 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $13 | $198 | $320 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $25 | $86 | $148 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $248 | $382 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $17 | $210 | $403 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $33 | $687 | $1,162 |