| 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 | $21 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $23 | $23 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $31 | $31 | $31 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $27 | $27 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $22 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $11 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $19 | $29 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $318 | $362 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $238 | $248 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $103 | $113 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $100 | $106 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $46 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $187 | $211 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $129 | $131 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $237 | $237 | $237 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $122 | $122 | $122 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $88 | $88 | $88 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $88 | $88 | $88 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $141 | $141 | $141 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $99 | $99 | $99 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $122 | $122 | $122 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $180 | $180 | $180 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $66 | $66 | $66 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $109 | $109 | $109 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $108 | $108 | $108 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $119 | $119 | $119 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $120 | $120 | $120 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $131 | $131 | $131 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $111 | $111 | $111 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $27 | $37 | $48 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $81 | $132 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $309 | $527 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $338 | $433 | $527 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $126 | $145 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $194 | $224 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $139 | $150 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $198 | $198 | $198 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $201 | $201 | $201 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $443 | $443 | $443 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $474 | $474 | $474 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $566 | $566 | $566 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,298 | $1,298 | $1,298 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $83 | $83 | $83 |
| Spirometry CPT 94010 • Pulmonology | $20 | $20 | $20 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $31 | $31 | $31 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $28 | $28 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $14 | $14 |