| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $56 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $16 | $16 | $16 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $30 | $30 | $30 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $25 | $25 | $25 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $26 | $26 | $26 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $30 | $30 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $27 | $27 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $25 | $25 | $25 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $4 | $4 | $4 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $4 | $4 | $4 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $272 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $123 | $123 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $117 | $117 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $59 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $35 | $35 | $35 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $79 | $79 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $83 | $83 | $83 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $107 | $107 | $107 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $116 | $116 | $116 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $60 | $60 | $60 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $67 | $67 | $67 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $66 | $66 | $66 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $74 | $74 | $74 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $75 | $75 | $75 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $91 | $91 | $91 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $35 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $106 | $106 | $106 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $459 | $459 | $459 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $459 | $459 | $459 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $74 | $74 | $74 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $137 | $137 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $92 | $92 | $92 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $239 | $239 | $239 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $217 | $217 | $217 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $209 | $209 | $209 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $235 | $235 | $235 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $265 | $265 | $265 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $931 | $931 | $931 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $80 | $80 | $80 |