| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $69 | $83 | $95 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $87 | $121 | $181 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $47 | $55 | $59 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $44 | $66 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $27 | $31 | $35 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $29 | $34 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $28 | $32 | $35 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $56 | $86 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $37 | $42 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $5 | $8 | $14 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $12 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $9 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $244 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $252 | $266 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $83 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $68 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $43 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $168 | $185 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $90 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $225 | $239 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $49 | $49 | $49 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $5 | $108 | $182 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $9 | $133 | $202 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $9 | $120 | $198 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $48 | $151 | $238 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $34 | $161 | $231 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $13 | $129 | $268 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $45 | $202 | $291 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $7 | $60 | $125 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $38 | $112 | $185 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $8 | $89 | $185 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $61 | $115 | $203 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $42 | $149 | $208 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $14 | $131 | $207 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $15 | $121 | $182 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $5 | $19 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $38 | $180 | $331 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $313 | $473 | $632 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $25 | $195 | $365 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $152 | $176 | $223 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $151 | $200 | $296 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $118 | $146 | $200 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $13 | $321 | $485 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $201 | $333 | $537 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $129 | $214 | $266 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $34 | $458 | $682 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $170 | $279 | $348 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $245 | $1,043 | $2,446 |