| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $37 | $37 | $37 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $25 | $25 | $25 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $9 | $9 | $9 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $10 | $10 | $10 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $8 | $8 | $8 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $9 | $9 | $9 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $10 | $10 | $10 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $9 | $9 | $9 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $4 | $4 | $4 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $9 | $9 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $6 | $6 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $138 | $138 | $138 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $102 | $102 | $102 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $44 | $44 | $44 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $9 | $9 | $9 |
| MMR vaccine CPT 90707 • Preventive Care | $43 | $43 | $43 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $22 | $22 | $22 |
| Varicella vaccine CPT 90716 • Preventive Care | $82 | $82 | $82 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $53 | $53 | $53 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $97 | $97 | $97 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $56 | $56 | $56 |
| 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 | $43 | $43 | $43 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $68 | $68 | $68 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $66 | $66 | $66 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $77 | $77 | $77 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $64 | $64 | $64 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $50 | $50 | $50 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $53 | $53 | $53 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $38 | $38 | $38 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $43 | $43 | $43 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $59 | $59 | $59 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $64 | $64 | $64 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $51 | $51 | $51 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $0 | $0 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $97 | $97 | $97 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $176 | $176 | $176 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $94 | $94 | $94 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $86 | $86 | $86 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $129 | $129 | $129 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $101 | $101 | $101 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $101 | $101 | $101 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $213 | $213 | $213 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $68 | $68 | $68 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $50 | $50 | $50 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $121 | $121 | $121 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $167 | $167 | $167 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $47 | $47 | $47 |
| Spirometry CPT 94010 • Pulmonology | $14 | $14 | $14 |