| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $30 | $30 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $23 | $23 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $22 | $22 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $23 | $23 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $33 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $32 | $35 |
| 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 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $98 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $76 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $110 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $77 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $19 | $119 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $106 | $107 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $111 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $113 | $115 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $127 | $129 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $123 | $125 | $126 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $142 | $144 | $147 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $159 | $159 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $102 | $103 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $73 | $88 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $82 | $97 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $121 | $121 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $130 | $130 | $131 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $39 | $39 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $183 | $184 | $185 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $341 | $341 | $341 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $92 | $92 | $92 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $168 | $168 | $168 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $165 | $168 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $129 | $131 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $294 | $294 | $295 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $326 | $326 | $326 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $167 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $222 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,477 | $1,477 | $1,477 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $94 | $94 | $94 |
| Spirometry CPT 94010 • Pulmonology | $26 | $28 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $34 | $38 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $61 | $61 | $61 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $34 | $38 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $154 | $154 | $154 |