| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $47 | $115 | $180 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $23 | $92 | $180 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $16 | $62 | $122 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $19 | $42 | $77 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $20 | $52 | $77 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $17 | $49 | $68 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $18 | $40 | $74 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $21 | $42 | $85 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $18 | $37 | $74 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $19 | $30 | $54 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $17 | $27 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $26 | $54 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $14 | $27 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $50 | $354 | $668 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $361 | $560 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $123 | $214 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $31 | $49 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $129 | $207 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $10 | $70 | $106 |
| Varicella vaccine CPT 90716 • Preventive Care | $39 | $208 | $397 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $137 | $254 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $221 | $309 | $468 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $77 | $77 | $77 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $86 | $134 | $216 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $64 | $119 | $163 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $34 | $131 | $235 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $11 | $153 | $266 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $102 | $161 | $258 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $18 | $181 | $299 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $65 | $202 | $324 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $6 | $103 | $194 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $41 | $127 | $185 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $82 | $129 | $207 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $34 | $122 | $173 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $70 | $133 | $232 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $49 | $128 | $193 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $11 | $154 | $266 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $8 | $38 | $68 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $124 | $309 | $493 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $238 | $431 | $802 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $98 | $491 | $1,413 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $126 | $204 | $322 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $168 | $223 | $332 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $114 | $151 | $222 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $21 | $229 | $487 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $24 | $257 | $490 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $12 | $415 | $998 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $14 | $266 | $569 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $23 | $452 | $1,211 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $105 | $1,315 | $2,893 |