| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $61 | $102 | $200 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $71 | $149 | $241 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $69 | $149 | $241 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $24 | $91 | $165 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $46 | $77 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $33 | $48 | $77 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $44 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $29 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $45 | $56 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $35 | $41 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $22 | $34 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $22 | $31 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $25 | $34 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $14 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $288 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $389 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $106 | $122 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $27 | $36 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $63 | $108 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $54 | $63 |
| Varicella vaccine CPT 90716 • Preventive Care | $107 | $155 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $178 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $193 | $220 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $51 | $51 | $51 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $132 | $173 | $219 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $73 | $141 | $229 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $83 | $145 | $202 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $72 | $179 | $291 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $107 | $198 | $260 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $83 | $169 | $301 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $147 | $212 | $278 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $36 | $127 | $213 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $160 | $226 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $73 | $113 | $173 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $151 | $230 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $86 | $130 | $235 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $181 | $250 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $36 | $193 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $48 | $59 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $26 | $177 | $285 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $185 | $342 | $545 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $126 | $420 | $793 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $134 | $194 | $253 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $152 | $234 | $323 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $131 | $207 | $254 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $242 | $480 | $606 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $308 | $487 | $680 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $333 | $478 | $628 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $197 | $493 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $211 | $368 | $442 |