| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $29 | $29 | $29 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $227 | $227 | $227 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $95 | $95 | $95 |
| Microdissection manual CPT 88381 • Pathology | $167 | $167 | $167 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $3 | $3 | $4 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $7 | $7 | $7 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $7 | $7 | $7 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $9 | $9 | $9 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $8 | $8 | $8 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $18 | $18 | $18 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $21 | $21 | $21 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $18 | $18 | $18 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $17 | $17 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $11 | $11 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $63 | $63 | $63 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $63 | $63 | $63 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $44 | $44 | $44 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $23 | $23 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $20 | $20 | $20 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $20 | $20 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $21 | $21 | $21 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $30 | $30 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $26 | $26 |
| 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 | $5 | $8 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $394 | $394 | $394 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $271 | $271 | $271 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $140 | $140 | $140 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $258 | $258 | $258 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $90 | $90 | $90 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $110 | $110 | $111 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $81 | $81 | $81 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $86 | $86 | $86 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $69 | $69 | $69 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $111 | $111 | $111 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $31 | $31 | $31 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $201 | $201 | $201 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $95 | $95 | $96 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $95 | $95 | $95 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $74 | $74 | $74 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $287 | $287 | $287 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $198 | $198 | $198 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $83 | $83 | $83 |
| Spirometry CPT 94010 • Pulmonology | $24 | $33 | $42 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $42 | $42 | $42 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $42 | $42 | $42 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $13 | $13 | $13 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $42 | $42 | $42 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $42 | $42 | $42 |