| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $27 | $33 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $29 | $46 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $17 | $25 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $26 | $43 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $19 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $271 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $257 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $21 | $83 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $19 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $103 | $106 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $34 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $196 | $207 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $96 | $135 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $235 | $248 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $99 | $168 | $215 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $36 | $132 | $200 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $11 | $151 | $234 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $91 | $145 | $200 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $87 | $131 | $192 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $16 | $157 | $297 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $145 | $181 | $251 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $9 | $109 | $193 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $10 | $95 | $207 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $9 | $80 | $151 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $104 | $159 | $201 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $11 | $115 | $231 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $9 | $139 | $219 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $91 | $178 | $265 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $7 | $37 | $72 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $24 | $163 | $315 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $17 | $256 | $596 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $85 | $340 | $596 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $139 | $204 | $322 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $139 | $207 | $332 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $108 | $150 | $224 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $19 | $231 | $446 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $63 | $269 | $490 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $179 | $218 | $256 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $64 | $337 | $625 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $342 | $503 | $665 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $209 | $1,021 | $1,772 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $120 | $176 |
| Spirometry CPT 94010 • Pulmonology | $13 | $29 | $49 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $7 | $51 | $109 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $12 | $61 | $111 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $7 | $19 | $28 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $148 | $197 | $296 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $4 | $15 | $33 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $8 | $19 | $31 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $11 | $53 | $98 |