| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $71 | $71 | $71 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $48 | $48 | $48 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $26 | $26 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $26 | $26 | $26 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $24 | $24 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $25 | $25 | $25 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $28 | $28 | $28 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $25 | $25 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $32 | $32 | $32 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $16 | $16 | $16 |
| Immunization admin injection single CPT 90471 • Preventive Care | $28 | $28 | $28 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $14 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $394 | $394 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $310 | $310 | $310 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $122 | $122 | $122 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $27 | $27 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $116 | $116 | $116 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $60 | $60 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $259 | $259 | $259 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $59 | $59 | $59 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $80 | $80 | $80 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $103 | $103 | $103 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $103 | $103 | $103 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $165 | $165 | $165 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $139 | $139 | $139 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $100 | $100 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $80 | $80 | $80 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $111 | $111 | $111 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $122 | $122 | $122 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $123 | $123 | $123 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $134 | $134 | $134 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $151 | $151 | $151 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $46 | $46 | $46 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $81 | $81 | $81 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $491 | $491 | $491 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $491 | $491 | $491 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $177 | $177 | $177 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $225 | $225 | $225 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $149 | $149 | $149 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $390 | $390 | $390 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $421 | $421 | $421 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $195 | $195 | $195 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $425 | $425 | $425 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $502 | $502 | $502 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $326 | $326 | $326 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $120 | $120 | $120 |