| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $70 | $70 | $70 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $70 | $70 | $70 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $48 | $48 | $49 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $25 | $25 | $25 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $23 | $23 | $23 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $22 | $22 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $23 | $23 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $33 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $29 | $29 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| 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 | $230 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $104 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $100 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $195 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $93 | $93 | $94 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $97 | $97 | $97 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $101 | $101 | $101 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $115 | $115 | $115 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $111 | $111 | $111 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $128 | $128 | $128 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $139 | $139 | $139 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $84 | $84 | $84 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $64 | $64 | $64 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $74 | $74 | $74 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $106 | $106 | $106 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $115 | $115 | $115 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $36 | $36 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $318 | $318 | $318 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $318 | $318 | $318 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $157 | $157 | $157 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $156 | $156 | $156 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $122 | $122 | $122 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $243 | $243 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $270 | $270 | $270 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $342 | $342 | $342 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,230 | $1,230 | $1,230 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $85 | $85 | $85 |
| Spirometry CPT 94010 • Pulmonology | $24 | $24 | $25 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $35 | $35 | $35 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $56 | $56 | $56 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $13 | $13 | $13 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $141 | $141 | $141 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $8 | $8 | $8 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $15 | $15 | $15 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $49 | $49 | $50 |