| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $1 | $34 | $63 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $1 | $31 | $58 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $1 | $25 | $56 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $1 | $32 | $60 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $1 | $41 | $84 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $1 | $29 | $74 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $27 | $41 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $14 | $22 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $23 | $37 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $26 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $391 | $521 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $306 | $428 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $123 | $167 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $26 | $34 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $117 | $166 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $44 | $56 | $66 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $230 | $310 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $159 | $222 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $265 | $365 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $149 | $215 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $61 | $142 | $225 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $61 | $157 | $234 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $69 | $165 | $263 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $99 | $170 | $255 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $84 | $192 | $296 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $92 | $211 | $321 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $46 | $122 | $193 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $139 | $207 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $53 | $131 | $206 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $61 | $136 | $226 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $82 | $155 | $231 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $90 | $162 | $245 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $74 | $163 | $263 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $26 | $42 | $68 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $65 | $149 | $355 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $389 | $455 | $593 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $231 | $469 | $688 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $192 | $337 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $224 | $336 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $157 | $228 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $162 | $318 | $441 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $298 | $424 | $631 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $164 | $325 | $449 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $192 | $411 | $608 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $206 | $402 | $829 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $274 | $689 | $1,380 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $79 | $101 | $156 |
| Spirometry CPT 94010 • Pulmonology | $7 | $27 | $48 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $14 | $48 | $69 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $26 | $57 | $91 |