| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $26 | $27 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $24 | $26 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $22 | $22 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $24 | $24 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $28 | $31 | $35 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $24 | $24 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $6 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $17 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $19 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $253 | $253 | $253 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $214 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $94 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $94 | $97 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $44 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $190 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $127 | $130 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $190 | $190 | $190 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $90 | $104 | $117 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $114 | $122 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $101 | $114 | $127 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $113 | $113 | $113 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $110 | $124 | $139 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $106 | $106 | $106 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $174 | $174 | $174 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $91 | $91 | $91 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $97 | $104 | $112 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $78 | $83 | $88 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $97 | $106 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $111 | $122 | $133 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $113 | $113 | $113 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $33 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $133 | $133 | $133 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $58 | $58 | $58 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $154 | $154 | $154 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $159 | $159 | $159 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $108 | $114 | $121 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $252 | $252 | $252 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $267 | $267 | $267 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $252 | $252 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $267 | $267 | $267 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $298 | $298 | $298 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $747 | $747 | $747 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $86 | $86 |
| Spirometry CPT 94010 • Pulmonology | $25 | $31 | $37 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $32 | $47 | $62 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $59 | $59 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $32 | $32 | $32 |