| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $24 | $42 | $49 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $21 | $32 | $44 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $23 | $40 | $47 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $24 | $42 | $51 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $23 | $34 | $46 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $26 | $43 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $15 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $28 | $34 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $14 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $302 | $357 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $253 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $115 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $23 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $109 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $59 | $62 |
| Varicella vaccine CPT 90716 • Preventive Care | $180 | $210 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $135 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $201 | $242 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $75 | $106 | $149 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $85 | $128 | $161 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $85 | $128 | $159 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $96 | $132 | $173 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $100 | $136 | $173 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $123 | $172 | $203 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $134 | $176 | $221 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $64 | $83 | $122 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $78 | $113 | $134 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $78 | $113 | $132 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $117 | $145 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $84 | $115 | $147 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $100 | $149 | $197 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $96 | $130 | $171 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $22 | $47 | $60 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $51 | $118 | $208 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $95 | $464 | $615 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $197 | $361 | $615 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $160 | $256 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $251 | $302 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $161 | $202 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $76 | $386 | $506 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $76 | $360 | $556 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $58 | $265 | $517 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $89 | $350 | $552 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $155 | $459 | $661 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $274 | $1,138 | $1,911 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $75 | $122 | $141 |
| Spirometry CPT 94010 • Pulmonology | $11 | $39 | $55 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $23 | $71 | $94 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $61 | $87 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $15 | $46 | $60 |