| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $155 | $155 | $155 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $156 | $156 | $156 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $40 | $40 | $40 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $22 | $39 | $55 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $19 | $19 | $19 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $19 | $19 | $19 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $19 | $19 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $30 | $30 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $24 | $24 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $17 | $22 | $33 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $10 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $14 | $29 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $20 | $20 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $209 | $209 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $56 | $56 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $140 | $140 | $140 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $82 | $117 | $152 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $165 | $165 | $165 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $101 | $101 | $101 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $212 | $212 | $212 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $209 | $209 | $209 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $55 | $55 | $55 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $156 | $156 | $156 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $60 | $103 | $145 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $95 | $95 | $95 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $71 | $112 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $191 | $191 | $191 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $101 | $145 | $190 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $36 | $36 | $36 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $331 | $331 | $331 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $162 | $162 | $162 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $109 | $109 | $109 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $148 | $169 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $199 | $214 | $229 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $199 | $199 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $96 | $96 | $96 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $265 | $265 | $265 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $332 | $332 | $332 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $86 | $86 |
| Spirometry CPT 94010 • Pulmonology | $12 | $19 | $27 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $16 | $16 | $16 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $39 | $39 | $39 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $38 | $68 | $99 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $40 | $40 | $40 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $98 | $98 | $98 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $3 | $3 | $3 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $24 | $24 | $24 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $77 | $77 | $77 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $485 | $485 | $485 |