| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $78 | $151 | $224 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $53 | $66 | $78 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $34 | $71 | $108 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $47 | $59 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $30 | $30 | $30 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $32 | $32 | $32 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $38 | $39 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $32 | $32 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $24 | $39 | $54 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $16 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $30 | $54 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $16 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $357 | $386 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $262 | $265 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $111 | $120 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $23 | $23 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $106 | $115 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $46 | $48 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $208 | $225 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $135 | $153 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $367 | $519 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $44 | $44 | $44 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $147 | $187 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $153 | $195 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $85 | $145 | $204 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $132 | $143 | $155 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $96 | $159 | $223 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $204 | $259 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $160 | $221 | $281 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $137 | $179 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $75 | $103 | $132 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $111 | $120 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $85 | $134 | $183 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $115 | $149 | $184 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $168 | $214 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $197 | $262 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $51 | $65 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $159 | $159 | $159 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $187 | $189 | $191 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $191 | $303 | $415 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $161 | $222 | $283 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $166 | $228 | $291 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $112 | $154 | $197 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $144 | $421 | $698 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $320 | $554 | $787 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $94 | $199 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $382 | $671 | $960 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $189 | $261 | $333 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $865 | $1,331 | $1,797 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $92 | $92 | $92 |