| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $23 | $28 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $22 | $22 | $23 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $25 | $32 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $251 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $14 | $59 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $57 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $38 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $29 | $112 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $20 | $20 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $229 | $239 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $31 | $69 | $107 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $12 | $63 | $115 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $7 | $93 | $159 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $53 | $122 | $180 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $78 | $124 | $174 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $17 | $111 | $203 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $19 | $71 | $123 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $10 | $36 | $62 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $15 | $44 | $72 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $31 | $68 | $105 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $113 | $115 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $7 | $61 | $115 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $18 | $56 | $94 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $16 | $16 | $16 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $13 | $23 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $35 | $53 | $72 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $51 | $253 | $456 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $71 | $205 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $100 | $132 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $117 | $130 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $126 | $127 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $13 | $165 | $318 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $27 | $186 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $36 | $181 | $326 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $21 | $217 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $17 | $30 | $42 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $700 | $823 | $947 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $74 | $77 | $80 |
| Spirometry CPT 94010 • Pulmonology | $32 | $39 | $45 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $34 | $44 | $54 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $40 | $52 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $42 | $42 | $43 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $82 | $113 | $143 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $14 | $14 | $14 |