| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $32 | $32 | $33 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $17 | $17 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $55 | $55 | $55 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $15 | $15 | $15 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $16 | $16 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $23 | $23 | $23 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $19 | $19 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $17 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $20 | $20 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $465 | $465 | $465 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $258 | $258 | $258 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $91 | $104 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $164 | $164 | $164 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $136 | $136 | $136 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $57 | $57 | $57 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $104 | $104 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $65 | $65 | $65 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $115 | $115 | $115 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $77 | $91 | $105 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $45 | $45 | $45 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $288 | $288 | $288 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $143 | $143 | $143 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $137 | $195 | $254 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $136 | $136 | $136 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $107 | $107 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $256 | $256 | $256 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $175 | $175 | $175 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $68 | $68 | $68 |
| Spirometry CPT 94010 • Pulmonology | $11 | $11 | $11 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $38 | $38 | $38 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $10 | $10 | $10 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $15 | $15 | $15 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $42 | $42 | $42 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $34 | $34 | $34 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $1 | $1 | $1 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $20 | $20 | $20 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $72 | $72 | $72 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $186 | $186 | $186 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $953 | $953 | $953 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $1,255 | $2,142 | $3,030 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $84 | $84 | $84 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $56 | $56 | $56 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $769 | $769 | $770 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $2,857 | $2,857 | $2,857 |
| Radiation treatment delivery superficial CPT 77407 • Radiation Therapy | $459 | $459 | $459 |
| Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy | $127 | $127 | $127 |
| Radiation therapy management complete course CPT 77431 • Radiation Therapy | $178 | $178 | $178 |
| Proton beam treatment simple CPT 77520 • Radiation Therapy | $605 | $605 | $605 |