| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $83 | $105 | $149 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $83 | $100 | $149 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $105 | $149 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $68 | $101 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $59 | $61 | $64 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $59 | $61 | $64 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $47 | $57 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $56 | $58 | $61 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $64 | $66 | $70 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $52 | $61 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $35 | $47 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $22 | $22 | $24 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $33 | $47 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $19 | $24 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $309 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $290 | $303 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $98 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $26 | $30 | $32 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $98 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $55 | $56 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $143 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $103 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $19 | $151 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $71 | $71 | $71 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $158 | $188 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $166 | $196 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $159 | $185 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $176 | $231 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $203 | $210 | $225 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $196 | $235 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $255 | $264 | $282 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $121 | $142 | $152 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $140 | $163 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $148 | $179 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $155 | $178 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $157 | $202 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $182 | $216 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $170 | $210 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $47 | $72 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $123 | $327 | $670 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $338 | $592 | $736 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $586 | $655 | $736 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $193 | $283 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $195 | $292 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $145 | $197 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $414 | $650 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $586 | $629 | $650 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $441 | $650 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $450 | $650 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $525 | $709 |