| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $10 | $10 | $10 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $10 | $11 | $12 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $9 | $10 | $12 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $19 | $19 | $19 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $26 | $26 | $26 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $19 | $22 | $25 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $17 | $17 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $11 | $11 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $81 | $82 | $84 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $81 | $81 | $81 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $46 | $46 | $46 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $24 | $24 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $21 | $21 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $20 | $21 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $22 | $22 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $37 | $37 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $31 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $18 |
| 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 | $92 | $92 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $93 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $163 | $163 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $73 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $187 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $94 | $94 | $94 |
| 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 | $116 | $116 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $116 | $116 | $116 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $129 | $138 | $148 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $126 | $149 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $98 | $105 | $112 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $123 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $133 | $133 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $38 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $184 | $201 | $219 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $259 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $185 | $185 | $186 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $174 | $185 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $117 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $268 | $268 | $268 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $154 | $277 |
| 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 | $1,278 | $1,278 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $96 | $96 | $96 |