| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $68 | $76 | $84 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $46 | $60 | $81 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $32 | $37 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $25 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $26 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $28 | $28 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $41 | $48 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $33 | $33 | $33 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $11 | $13 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $9 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $13 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $150 | $226 | $274 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $199 | $286 | $331 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $79 | $95 | $110 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $17 | $28 | $42 |
| MMR vaccine CPT 90707 • Preventive Care | $74 | $98 | $112 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $50 | $66 |
| Varicella vaccine CPT 90716 • Preventive Care | $148 | $174 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $90 | $127 | $159 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $166 | $195 | $220 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $33 | $33 | $33 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $87 | $118 | $157 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $65 | $100 | $132 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $124 | $172 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $108 | $125 | $156 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $104 | $150 | $187 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $121 | $166 | $194 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $131 | $184 | $236 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $56 | $108 | $141 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $84 | $114 | $151 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $107 | $150 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $81 | $97 | $133 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $71 | $95 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $100 | $135 | $180 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $95 | $132 | $194 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $37 | $45 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $45 | $45 | $45 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $201 | $284 | $402 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $149 | $274 | $403 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $130 | $173 | $194 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $133 | $174 | $194 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $90 | $129 | $152 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $191 | $281 | $371 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $213 | $315 | $417 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $156 | $195 | $216 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $125 | $350 | $510 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $36 | $289 | $542 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $869 | $1,217 | $1,521 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $73 | $73 | $73 |