| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $23 | $23 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $21 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $70 | $70 | $70 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $71 | $71 | $71 |
| Physical therapy evaluation high complexity CPT 97163 • 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 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $57 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $76 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $20 | $20 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $120 | $120 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $106 | $107 |
| 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 | $115 | $115 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $131 | $131 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $126 | $126 | $126 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $146 | $146 | $147 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $159 | $159 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $103 | $103 | $103 |
| 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 | $112 | $112 | $112 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $121 | $121 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $131 | $131 | $131 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $39 | $39 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $185 | $185 | $185 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $341 | $341 | $341 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $168 | $168 | $168 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $167 | $167 | $168 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $130 | $130 | $131 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $294 | $294 | $295 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $326 | $326 | $326 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $160 | $232 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $413 | $413 | $414 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $442 | $442 | $442 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,477 | $1,477 | $1,477 |