| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $155 | $155 | $155 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $156 | $156 | $156 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $54 | $54 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $25 | $25 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $26 | $26 | $26 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $36 | $36 | $36 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $33 | $33 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $13 | $13 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $18 | $18 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $20 | $20 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $209 | $209 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $92 | $92 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $19 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $80 | $80 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $65 | $65 | $65 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $157 | $157 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $122 | $122 | $122 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $225 | $225 | $225 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $152 | $152 | $152 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $92 | $92 | $92 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $165 | $165 | $165 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $126 | $126 | $126 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $104 | $104 | $104 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $226 | $226 | $226 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $131 | $131 | $131 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $78 | $78 | $78 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $156 | $156 | $156 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $145 | $145 | $145 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $91 | $91 | $91 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $138 | $138 | $138 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $118 | $118 | $118 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $190 | $190 | $190 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $37 | $37 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $173 | $173 | $173 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $173 | $173 | $173 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $156 | $156 | $156 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $156 | $156 | $156 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $169 | $169 | $169 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $199 | $199 | $199 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $199 | $199 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $202 | $202 | $202 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $126 | $126 | $126 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $265 | $265 | $265 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $332 | $332 | $332 |
| Spirometry CPT 94010 • Pulmonology | $12 | $12 | $12 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $16 | $16 | $16 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $24 | $24 | $24 |