| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $68 | $76 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $78 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $55 | $58 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $40 | $59 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $25 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $29 | $31 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $48 | $64 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $33 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $21 | $42 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $14 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $284 | $339 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $243 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $100 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $74 | $86 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $42 | $46 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $134 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $105 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $166 | $245 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $36 | $36 | $36 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $87 | $98 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $97 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $101 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $95 | $108 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $158 | $159 | $161 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $84 | $118 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $125 | $125 | $125 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $79 | $85 | $91 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $127 | $167 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $112 | $123 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $81 | $119 | $178 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $130 | $188 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $77 | $102 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $132 | $215 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $27 | $35 | $45 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $143 | $170 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $254 | $342 | $430 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $231 | $231 | $231 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $195 | $260 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $198 | $267 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $121 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $111 | $191 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $106 | $106 | $106 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $25 | $192 | $359 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $151 | $272 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $129 | $292 | $455 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,089 | $1,184 | $1,278 |