| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $110 | $173 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $110 | $173 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $37 | $76 | $158 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $45 | $67 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $44 | $69 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $40 | $67 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $42 | $71 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $45 | $72 | $100 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $40 | $62 | $85 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $19 | $35 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $13 | $17 | $25 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $30 | $49 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $19 | $26 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $334 | $398 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $376 | $607 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $150 | $275 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $33 | $53 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $147 | $263 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $62 | $66 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $271 | $515 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $135 | $161 | $190 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $210 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $58 | $58 | $58 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $95 | $143 | $250 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $132 | $176 | $262 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $117 | $162 | $274 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $93 | $157 | $263 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $143 | $311 | $550 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $151 | $169 | $177 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $210 | $423 | $637 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $91 | $95 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $82 | $111 | $181 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $88 | $115 | $150 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $110 | $146 | $226 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $129 | $162 | $216 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $241 | $516 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $61 | $140 | $263 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $45 | $75 | $128 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $110 | $146 | $182 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $195 | $281 | $477 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $203 | $317 | $477 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $159 | $242 | $374 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $189 | $217 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $153 | $206 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $477 | $629 | $721 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $188 | $478 | $767 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $36 | $277 | $475 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $415 | $635 | $982 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $283 | $542 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $282 | $1,644 | $3,131 |