| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $34 | $34 | $34 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $33 | $33 | $34 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $35 | $35 | $35 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $50 | $50 | $50 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $42 | $42 | $42 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $15 | $15 | $15 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $7 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $15 | $15 | $15 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $7 | $7 | $7 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $104 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $100 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $195 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $17 | $63 | $110 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $116 | $116 | $116 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $121 | $121 | $121 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $102 | $119 | $137 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $132 | $132 | $132 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $166 | $166 | $166 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $76 | $76 | $76 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $127 | $127 | $127 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $137 | $137 | $137 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $39 | $39 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $56 | $56 | $56 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $28 | $180 | $332 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $332 | $332 | $332 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $166 | $166 | $166 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $170 | $170 | $170 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $115 | $115 | $115 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $243 | $243 | $244 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $272 | $272 | $272 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $45 | $45 | $45 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $348 | $348 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $45 | $45 | $45 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,120 | $1,120 | $1,120 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $92 | $92 | $92 |
| Spirometry CPT 94010 • Pulmonology | $35 | $40 | $45 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $59 | $59 | $59 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $59 | $59 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $39 | $39 | $39 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $160 | $160 | $160 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $45 | $45 | $45 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $45 | $45 | $45 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $54 | $54 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $44 | $44 | $44 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $57 | $57 | $57 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $2 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $27 | $27 | $27 |