| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $84 | $100 | $115 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $106 | $121 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $34 | $56 | $79 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $37 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $24 | $34 | $47 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $25 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $25 | $34 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $34 | $36 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $30 | $30 | $31 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $12 | $21 | $39 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $13 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $17 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $7 | $12 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $328 | $347 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $303 | $382 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $112 | $122 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $30 | $42 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $76 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $55 | $70 |
| Varicella vaccine CPT 90716 • Preventive Care | $199 | $210 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $137 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $206 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $42 | $42 | $42 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $12 | $84 | $148 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $110 | $128 | $158 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $110 | $131 | $161 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $125 | $149 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $125 | $146 | $180 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $88 | $133 | $205 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $151 | $180 | $223 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $60 | $106 | $136 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $12 | $112 | $195 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $91 | $109 | $144 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $100 | $136 | $159 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $102 | $135 | $168 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $112 | $137 | $173 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $21 | $109 | $186 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $43 | $49 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $84 | $84 | $84 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $27 | $228 | $515 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $122 | $302 | $515 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $147 | $158 | $164 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $275 | $296 | $316 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $155 | $183 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $183 | $320 | $479 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $234 | $287 | $340 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $188 | $323 | $578 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $215 | $366 | $450 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $123 | $382 | $618 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $152 | $989 | $1,534 |