| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $21 | $22 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $22 | $22 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $31 | $31 | $31 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $26 | $26 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $7 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $21 | $31 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $19 |
| 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 | $21 | $64 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $40 |
| Varicella vaccine CPT 90716 • Preventive Care | $124 | $160 | $195 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $219 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $98 | $98 | $99 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $103 | $145 | $187 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $107 | $151 | $195 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $122 | $163 | $204 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $117 | $165 | $212 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $136 | $172 | $209 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $147 | $147 | $147 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $127 | $127 | $127 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $14 | $80 | $146 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $94 | $133 | $171 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $103 | $146 | $188 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $180 | $180 | $180 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $113 | $152 | $190 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $14 | $93 | $174 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $43 | $43 | $43 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $21 | $21 | $21 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $184 | $184 | $184 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $190 | $190 | $190 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $128 | $128 | $128 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $22 | $26 | $30 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,073 | $1,073 | $1,073 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $99 | $99 | $99 |
| Spirometry CPT 94010 • Pulmonology | $37 | $37 | $37 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $30 | $30 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $30 | $30 | $30 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $30 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $100 | $170 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $56 | $56 | $57 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $13 | $30 | $46 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $13 | $20 | $26 |