| 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 | $39 | $39 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $33 | $33 | $33 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $33 | $33 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $34 | $34 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $46 | $46 | $46 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $40 | $40 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $22 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $17 | $17 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $22 | $22 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $17 | $17 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $102 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $97 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $50 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $192 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $117 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $216 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $28 | $28 | $28 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $146 | $146 | $146 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $109 | $109 | $109 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $159 | $159 | $159 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $180 | $180 | $180 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $174 | $174 | $174 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $202 | $202 | $202 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $170 | $170 | $170 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $131 | $131 | $131 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $140 | $140 | $140 |
| 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 | $154 | $154 | $154 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $119 | $119 | $119 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $129 | $129 | $129 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $180 | $180 | $180 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $36 | $36 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $75 | $75 | $75 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $421 | $421 | $421 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $421 | $421 | $421 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $219 | $219 | $219 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $226 | $226 | $226 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $152 | $152 | $152 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $177 | $177 | $177 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $346 | $346 | $346 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $181 | $181 | $181 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $442 | $442 | $442 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $238 | $238 | $238 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $300 | $300 | $300 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $124 | $124 | $124 |