| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $22 | $22 | $22 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $19 | $19 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $73 | $73 | $73 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $52 | $52 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $26 | $26 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $22 | $22 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $18 | $18 | $18 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $7 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $19 | $19 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $15 | $15 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $316 | $316 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $84 | $84 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $11 | $11 | $11 |
| MMR vaccine CPT 90707 • Preventive Care | $71 | $71 | $71 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $40 | $40 |
| Varicella vaccine CPT 90716 • Preventive Care | $157 | $157 | $157 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $113 | $113 | $113 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $176 | $176 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $98 | $98 | $98 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $93 | $93 | $93 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $112 | $112 | $112 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $105 | $105 | $105 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $118 | $118 | $118 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $156 | $156 | $156 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $75 | $75 | $75 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $92 | $92 | $92 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $94 | $94 | $94 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $111 | $111 | $111 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $99 | $99 | $99 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $111 | $111 | $111 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $140 | $140 | $140 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $136 | $136 | $136 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $61 | $61 | $61 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $71 | $71 | $71 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $202 | $202 | $202 |
| Spirometry CPT 94010 • Pulmonology | $21 | $21 | $21 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $30 | $30 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $31 | $31 | $31 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $6 | $6 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $12 | $12 | $12 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $7 | $7 | $7 |
| Sleep study unattended CPT 95800 • Sleep Medicine | $38 | $38 | $38 |
| Multiple sleep latency test (MSLT) CPT 95805 • Sleep Medicine | $57 | $57 | $57 |
| Polysomnography age 6 or older CPT 95810 • Sleep Medicine | $117 | $117 | $117 |
| Polysomnography with CPAP titration CPT 95811 • Sleep Medicine | $115 | $115 | $115 |
| Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine | $175 | $175 | $175 |
| CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine | $68 | $68 | $68 |