| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $16 | $29 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $7 | $16 | $27 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $7 | $13 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $11 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $338 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $260 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $107 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $104 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $37 | $48 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $182 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $119 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $94 | $216 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $57 | $89 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $60 | $95 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $63 | $100 | $174 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $74 | $110 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $71 | $105 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $86 | $123 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $95 | $135 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $51 | $70 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $55 | $83 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $55 | $80 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $63 | $92 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $65 | $93 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $70 | $101 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $75 | $113 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $31 | $44 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $141 | $219 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $208 | $326 | $396 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $170 | $294 | $397 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $136 | $185 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $150 | $169 | $190 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $124 | $145 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $213 | $350 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $136 | $257 | $350 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $225 | $358 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $264 | $385 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $298 | $415 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $201 | $806 | $1,443 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $84 | $92 | $100 |
| Spirometry CPT 94010 • Pulmonology | $8 | $18 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $19 | $34 | $59 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $25 | $40 | $66 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $13 | $26 | $41 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $71 | $125 | $201 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $7 | $16 | $30 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $15 | $19 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $13 | $49 | $62 |