| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $81 | $81 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $55 | $55 | $55 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $31 | $31 | $31 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $31 | $31 | $31 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $28 | $28 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $29 | $29 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $33 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $29 | $29 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $23 | $23 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $8 | $8 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $378 | $378 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $114 | $175 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $70 | $85 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $26 | $26 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $7 | $56 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $48 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $42 | $116 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $53 | $80 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $248 | $248 | $248 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $53 | $53 | $53 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $113 | $113 | $113 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $86 | $86 | $86 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $123 | $123 | $123 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $133 | $133 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $133 | $133 | $133 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $156 | $156 | $156 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $172 | $172 | $172 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $95 | $95 | $95 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $106 | $106 | $106 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $105 | $105 | $105 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $86 | $86 | $86 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $116 | $116 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $97 | $97 | $97 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $143 | $143 | $143 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $47 | $47 | $47 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $81 | $81 | $81 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $285 | $285 | $285 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $496 | $496 | $496 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $167 | $167 | $167 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $213 | $213 | $213 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $142 | $142 | $142 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $397 | $397 | $397 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $431 | $431 | $431 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $402 | $402 | $402 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $434 | $434 | $434 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $254 | $254 | $254 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,234 | $1,234 | $1,234 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $121 | $121 | $121 |