| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $80 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $92 | $117 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $53 | $63 | $80 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $31 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $48 | $65 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $33 | $52 | $63 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $25 | $30 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $46 | $52 | $57 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $38 | $40 | $41 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $21 | $41 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $19 | $34 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $336 | $344 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $283 | $301 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $112 | $119 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $27 | $41 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $76 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $69 | $93 |
| Varicella vaccine CPT 90716 • Preventive Care | $91 | $143 | $199 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $106 | $112 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $143 | $200 | $221 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $103 | $103 | $103 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $108 | $125 | $152 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $111 | $115 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $104 | $134 | $210 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $103 | $151 | $233 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $113 | $140 | $177 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $155 | $267 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $128 | $166 | $223 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $70 | $100 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $84 | $110 | $145 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $83 | $96 | $114 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $71 | $106 | $159 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $90 | $110 | $124 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $80 | $119 | $191 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $134 | $159 | $183 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $33 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $55 | $123 | $191 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $92 | $333 | $666 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $186 | $349 | $666 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $73 | $103 | $162 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $164 | $228 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $87 | $110 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $199 | $240 | $264 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $289 | $404 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $188 | $282 | $377 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $219 | $339 | $402 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $123 | $254 | $462 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $310 | $1,301 | $2,012 |