| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $46 | $64 | $80 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $23 | $45 | $67 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $31 | $36 | $47 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $20 | $25 | $29 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $20 | $22 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $17 | $19 | $21 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $18 | $20 | $23 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $21 | $25 | $32 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $18 | $22 | $28 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $23 | $23 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $11 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $16 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $11 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $219 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $77 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $18 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $73 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $34 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $144 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $100 | $132 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $162 | $244 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $39 | $39 | $39 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $43 | $59 | $86 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $32 | $66 | $90 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $9 | $61 | $94 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $11 | $50 | $89 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $86 | $97 | $103 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $12 | $68 | $99 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $13 | $83 | $129 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $12 | $47 | $66 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $6 | $38 | $70 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $8 | $46 | $82 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $10 | $33 | $55 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $70 | $74 | $78 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $10 | $56 | $98 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $53 | $71 | $89 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $14 | $26 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $125 | $145 | $166 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $48 | $137 | $227 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $30 | $129 | $227 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $87 | $138 | $164 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $111 | $137 | $151 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $87 | $108 | $118 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $87 | $133 | $208 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $18 | $144 | $231 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $33 | $101 | $170 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $43 | $186 | $283 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $45 | $153 | $301 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $98 | $543 | $827 |