| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $79 | $80 | $81 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $79 | $102 | $166 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $79 | $81 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $57 | $117 | $213 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $39 | $78 | $113 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $57 | $81 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $81 | $86 | $98 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $32 | $57 | $81 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $38 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $65 | $82 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $22 | $42 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $18 | $29 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $25 | $42 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $327 | $362 | $398 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $98 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $24 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $19 | $86 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $46 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $156 | $232 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $65 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $94 | $188 | $261 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $49 | $49 | $49 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $83 | $137 | $188 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $195 | $295 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $158 | $205 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $170 | $232 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $202 | $254 | $336 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $265 | $388 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $253 | $319 | $421 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $169 | $172 | $176 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $185 | $272 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $132 | $180 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $111 | $179 | $296 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $181 | $225 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $106 | $160 | $216 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $136 | $233 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $54 | $77 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $128 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $27 | $555 | $1,083 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $413 | $413 | $413 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $253 | $432 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $170 | $184 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $197 | $337 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $395 | $775 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $273 | $313 | $353 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $98 | $304 | $532 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $489 | $1,090 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $26 | $353 | $633 |