| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $25 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $26 | $33 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $31 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $11 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $328 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $262 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $101 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $79 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $45 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $144 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $77 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $94 | $184 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $52 | $93 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $104 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $85 | $107 | $137 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $97 | $113 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $68 | $107 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $113 | $137 | $149 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $123 | $123 | $123 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $65 | $72 | $83 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $60 | $82 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $72 | $87 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $79 | $96 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $80 | $98 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $89 | $112 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $15 | $90 | $131 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $35 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $49 | $96 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $174 | $249 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $286 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $86 | $137 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $154 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $116 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $110 | $271 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $79 | $128 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $146 | $278 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $119 | $296 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $129 | $207 | $352 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $838 | $1,058 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $77 | $84 | $91 |
| Spirometry CPT 94010 • Pulmonology | $19 | $27 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $37 | $47 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $49 | $54 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $18 | $24 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $66 | $108 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $17 | $30 |