| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $20 | $22 | $24 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $25 | $25 | $25 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $30 | $30 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $28 | $31 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $7 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $6 | $7 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $18 | $61 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $117 | $117 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $16 | $16 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $70 | $102 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $124 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $91 | $102 | $112 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $95 | $106 | $117 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $99 | $117 | $130 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $112 | $136 | $160 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $105 | $119 | $133 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $105 | $115 | $125 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $167 | $167 | $167 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $61 | $61 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $87 | $87 | $87 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $87 | $87 | $87 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $95 | $95 | $95 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $104 | $115 | $127 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $103 | $107 | $112 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $26 | $32 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $131 | $150 | $170 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $233 | $233 | $233 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $349 | $349 | $349 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $136 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $110 | $120 | $130 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $87 | $88 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $282 | $295 | $308 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $340 | $340 | $340 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $294 | $294 | $294 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $409 | $421 | $432 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $434 | $434 | $434 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,534 | $1,540 | $1,546 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $108 | $108 | $108 |
| Spirometry CPT 94010 • Pulmonology | $9 | $27 | $44 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $31 | $38 | $44 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $69 | $69 | $69 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $25 | $35 | $44 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $174 | $174 | $174 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $10 | $10 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $44 | $45 | $45 |