| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $67 | $67 | $67 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $46 | $46 | $46 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $26 | $29 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $25 | $25 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $23 | $23 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $23 | $23 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $20 | $20 | $20 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $22 | $22 | $22 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $20 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $17 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $9 | $9 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $355 | $355 | $355 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $244 | $244 | $244 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $111 | $111 | $111 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $21 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $105 | $105 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $53 | $53 | $53 |
| Varicella vaccine CPT 90716 • Preventive Care | $207 | $207 | $207 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $126 | $126 | $126 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $253 | $253 | $253 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $30 | $30 | $30 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $82 | $82 | $82 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $58 | $58 | $58 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $86 | $86 | $86 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $65 | $65 | $65 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $94 | $94 | $94 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $80 | $80 | $80 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $88 | $88 | $88 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $62 | $78 | $95 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $70 | $70 | $70 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $69 | $69 | $69 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $58 | $58 | $58 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $58 | $58 | $58 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $102 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $94 | $94 | $94 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $29 | $29 | $29 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $56 | $56 | $56 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $207 | $207 | $207 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $435 | $435 | $435 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $76 | $76 | $76 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $141 | $147 | $151 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $94 | $110 | $118 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $150 | $150 | $150 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $153 | $153 | $153 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $153 | $153 | $153 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $178 | $178 | $178 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $198 | $198 | $198 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $933 | $933 | $933 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $66 | $66 | $66 |