| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $23 | $25 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $23 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $10 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $17 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $14 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $354 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $252 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $112 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $107 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $55 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $209 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $130 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $251 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $106 | $126 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $61 | $96 | $132 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $61 | $99 | $137 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $127 | $156 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $69 | $110 | $151 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $125 | $135 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $125 | $157 | $189 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $46 | $62 | $79 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $80 | $86 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $97 | $121 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $81 | $106 | $132 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $82 | $91 | $100 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $90 | $100 | $110 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $100 | $108 | $116 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $16 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $66 | $105 | $143 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $400 | $415 | $430 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $215 | $322 | $430 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $191 | $294 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $228 | $293 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $170 | $230 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $162 | $301 | $441 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $96 | $130 | $164 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $359 | $405 | $450 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $113 | $152 | $192 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $275 | $365 | $455 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,089 | $1,638 | $2,187 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $79 | $93 | $106 |
| Spirometry CPT 94010 • Pulmonology | $7 | $8 | $9 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $14 | $24 | $34 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $42 | $47 | $52 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $17 | $24 | $32 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $64 | $71 | $78 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $10 | $11 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $17 | $21 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $41 | $54 | $66 |