| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $20 | $20 | $20 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $13 | $13 | $13 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $91 | $91 | $91 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $50 | $50 | $50 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $27 | $27 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $24 | $24 | $24 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $23 | $23 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $24 | $24 | $24 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $35 | $35 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $30 | $30 | $30 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $11 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $5 | $5 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $104 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $100 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $195 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $110 | $110 | $110 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $115 | $115 | $115 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $120 | $120 | $120 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $136 | $136 | $136 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $131 | $131 | $131 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $161 | $161 | $161 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $165 | $165 | $165 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $74 | $74 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $85 | $85 | $85 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $124 | $125 | $126 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $136 | $136 | $136 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $37 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $176 | $176 | $176 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $225 | $360 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $90 | $90 | $90 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $124 | $161 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $156 | $159 | $161 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $104 | $115 | $126 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $164 | $298 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $333 | $333 | $333 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $426 | $426 | $426 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $276 | $276 | $276 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $93 | $93 | $93 |
| Spirometry CPT 94010 • Pulmonology | $20 | $24 | $28 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $44 | $44 | $44 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $60 | $60 | $60 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $30 | $30 |