| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $28 | $45 | $69 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $23 | $43 | $81 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $26 | $46 | $86 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $37 | $60 | $95 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $32 | $56 | $87 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $25 | $39 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $7 | $12 | $19 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $23 | $35 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $18 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $391 | $716 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $300 | $480 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $115 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $14 | $23 | $39 |
| MMR vaccine CPT 90707 • Preventive Care | $72 | $117 | $214 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $53 | $74 |
| Varicella vaccine CPT 90716 • Preventive Care | $124 | $201 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $113 | $151 | $248 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $256 | $469 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $59 | $132 | $189 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $62 | $143 | $198 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $64 | $147 | $206 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $76 | $164 | $232 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $73 | $157 | $226 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $88 | $199 | $261 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $98 | $208 | $283 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $119 | $169 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $57 | $130 | $181 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $57 | $129 | $181 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $64 | $130 | $169 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $67 | $154 | $204 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $73 | $157 | $217 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $78 | $139 | $200 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $24 | $47 | $67 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $51 | $201 | $310 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $214 | $377 | $578 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $213 | $352 | $579 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $100 | $216 | $288 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $155 | $229 | $288 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $113 | $161 | $226 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $107 | $317 | $690 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $140 | $397 | $777 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $270 | $436 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $165 | $494 | $952 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $185 | $496 | $694 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $233 | $1,394 | $2,118 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $103 | $139 | $252 |
| Spirometry CPT 94010 • Pulmonology | $10 | $28 | $48 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $10 | $39 | $65 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $36 | $70 | $108 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $41 | $109 |