| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $31 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $29 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $21 | $31 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $27 | $40 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $19 | $31 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $218 | $368 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $389 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $108 | $114 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $33 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $87 | $108 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $52 | $96 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $169 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $162 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $139 | $241 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $6 | $152 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $64 | $178 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $34 | $174 | $270 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $40 | $115 | $189 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $12 | $164 | $298 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $93 | $239 | $345 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $100 | $237 | $373 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $8 | $69 | $130 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $42 | $119 | $172 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $13 | $102 | $192 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $67 | $115 | $211 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $35 | $173 | $267 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $100 | $206 | $287 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $8 | $188 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $58 | $79 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $116 | $141 | $166 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $130 | $319 | $673 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $87 | $381 | $674 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $125 | $226 | $300 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $156 | $239 | $307 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $122 | $176 | $208 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $96 | $399 | $606 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $96 | $442 | $680 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $26 | $312 | $628 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $23 | $531 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $259 | $502 | $746 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $164 | $1,271 | $3,182 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $123 | $190 |
| Spirometry CPT 94010 • Pulmonology | $12 | $36 | $70 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $7 | $53 | $116 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $29 | $49 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $21 | $35 | $47 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $79 | $132 | $173 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $1 | $18 | $34 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $8 | $18 | $32 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $26 | $52 | $80 |