| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $24 | $84 | $144 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $48 | $80 | $144 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $33 | $55 | $98 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $28 | $48 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $17 | $28 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $16 | $25 | $44 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $32 | $47 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $30 | $51 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $27 | $46 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $29 | $43 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $15 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $34 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $13 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $336 | $365 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $17 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $84 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $33 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $39 | $135 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $27 | $84 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $153 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $61 | $61 | $61 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $51 | $73 | $94 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $29 | $68 | $108 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $58 | $109 | $159 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $65 | $109 | $173 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $7 | $90 | $173 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $80 | $129 | $203 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $17 | $119 | $221 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $7 | $43 | $81 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $35 | $65 | $94 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $50 | $78 | $132 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $8 | $77 | $145 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $58 | $88 | $147 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $13 | $87 | $161 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $74 | $116 | $179 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $31 | $58 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $77 | $142 | $208 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $102 | $340 | $615 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $46 | $279 | $615 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $128 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $192 | $302 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $90 | $127 | $202 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $49 | $140 | $231 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $132 | $183 | $234 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $40 | $248 | $517 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $22 | $147 | $273 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $63 | $362 | $661 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $208 | $903 | $1,598 |