| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $22 | $27 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $24 | $27 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $15 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $23 | $26 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $17 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $336 | $395 | $436 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $254 | $307 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $89 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $28 | $34 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $91 | $122 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $60 | $63 |
| Varicella vaccine CPT 90716 • Preventive Care | $196 | $210 | $235 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $163 | $208 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $237 | $286 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $74 | $131 | $167 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $56 | $131 | $168 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $56 | $128 | $174 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $87 | $160 | $212 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $63 | $136 | $192 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $78 | $138 | $222 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $85 | $189 | $240 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $62 | $97 | $145 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $69 | $111 | $160 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $69 | $114 | $154 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $76 | $126 | $168 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $56 | $106 | $172 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $63 | $129 | $185 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $82 | $121 | $199 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $17 | $29 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $88 | $125 | $191 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $72 | $253 | $400 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $163 | $189 | $215 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $76 | $183 | $263 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $140 | $232 | $368 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $94 | $147 | $206 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $118 | $366 | $441 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $201 | $363 | $492 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $210 | $323 | $453 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $229 | $426 | $629 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $319 | $668 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $202 | $1,465 | $2,333 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $75 | $104 | $133 |
| Spirometry CPT 94010 • Pulmonology | $9 | $37 | $49 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $16 | $58 | $82 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $25 | $69 | $98 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $36 | $42 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $73 | $79 | $85 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $30 | $49 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $31 | $41 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $17 | $61 | $86 |