| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $26 | $27 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $12 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $8 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $50 | $219 | $388 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $255 | $304 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $80 | $120 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $4 | $17 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $78 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $34 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $29 | $150 | $226 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $79 | $138 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $145 | $254 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $6 | $60 | $90 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $32 | $73 | $97 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $14 | $68 | $97 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $53 | $79 | $105 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $75 | $93 | $103 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $14 | $68 | $123 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $20 | $94 | $135 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $8 | $54 | $77 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $30 | $57 | $84 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $6 | $45 | $84 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $34 | $63 | $92 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $14 | $40 | $67 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $10 | $61 | $97 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $54 | $69 | $84 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $21 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $51 | $83 | $125 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $155 | $309 | $462 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $31 | $247 | $462 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $122 | $133 | $153 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $155 | $158 | $162 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $112 | $122 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $119 | $164 | $229 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $51 | $211 | $328 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $65 | $186 | $307 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $151 | $267 | $330 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $170 | $180 | $189 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $219 | $527 | $1,135 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $88 | $89 | $91 |
| Spirometry CPT 94010 • Pulmonology | $8 | $22 | $33 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $14 | $28 | $36 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $32 | $49 | $58 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $29 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $88 | $125 | $145 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $1 | $8 | $15 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $8 | $11 | $15 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $25 | $38 | $50 |