| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $16 | $41 | $89 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $18 | $43 | $79 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $15 | $42 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $35 | $51 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $49 | $72 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $25 | $38 | $61 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $12 | $27 | $40 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $16 | $31 |
| Immunization admin injection single CPT 90471 • Preventive Care | $20 | $26 | $40 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $19 | $31 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $144 | $461 | $745 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $373 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $42 | $132 | $222 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $32 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $146 | $222 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $67 | $96 |
| Varicella vaccine CPT 90716 • Preventive Care | $120 | $268 | $435 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $193 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $274 | $488 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $94 | $154 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $101 | $156 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $68 | $163 | $270 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $76 | $178 | $308 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $88 | $171 | $298 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $94 | $201 | $345 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $139 | $237 | $373 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $121 | $225 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $59 | $127 | $239 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $59 | $136 | $238 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $77 | $147 | $261 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $84 | $151 | $267 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $76 | $166 | $287 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $85 | $165 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $48 | $99 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $63 | $139 | $285 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $140 | $408 | $881 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $140 | $426 | $882 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $98 | $207 | $413 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $169 | $247 | $413 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $116 | $174 | $323 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $159 | $336 | $606 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $185 | $436 | $680 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $265 | $366 | $628 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $187 | $527 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $170 | $561 | $924 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $201 | $1,493 | $3,204 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $104 | $138 |
| Spirometry CPT 94010 • Pulmonology | $18 | $32 | $67 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $15 | $49 | $94 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $29 | $73 | $147 |