| Gait training each 15 minutes CPT 97116 • Physical Therapy | $20 | $20 | $20 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $19 | $19 | $19 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $14 | $14 | $14 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $75 | $75 | $75 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $76 | $76 | $76 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $24 | $38 | $52 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $27 | $27 | $27 |
| 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 | $22 | $22 | $22 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $35 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $8 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $14 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $15 | $15 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $268 | $268 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $197 | $197 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $99 | $99 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $19 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $80 | $80 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $40 | $40 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $184 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $127 | $127 | $127 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $245 | $245 | $245 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $89 | $95 | $101 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $87 | $87 | $87 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $94 | $94 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $8 | $61 | $113 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $96 | $96 | $96 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $127 | $127 | $127 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $90 | $90 | $90 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $97 | $97 | $97 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $97 | $97 | $97 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $90 | $90 | $90 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $105 | $105 | $105 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $111 | $111 | $111 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $8 | $64 | $120 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $32 | $32 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $386 | $386 | $386 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $188 | $188 | $188 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $121 | $121 | $121 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $271 | $271 | $271 |
| Spirometry CPT 94010 • Pulmonology | $24 | $25 | $25 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $27 | $27 | $27 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $32 | $32 | $32 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $6 | $6 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $15 | $15 | $15 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $38 | $46 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $37 | $38 | $40 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $50 | $50 | $50 |