| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $29 | $29 | $29 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $24 | $24 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $35 | $35 | $35 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $29 | $29 | $29 |
| Immunization admin injection single CPT 90471 • Preventive Care | $29 | $29 | $29 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $25 | $25 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $362 | $362 | $362 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $238 | $238 | $238 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $91 | $91 | $91 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $21 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $78 | $78 | $78 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $55 | $55 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $134 | $134 | $134 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $129 | $129 | $129 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $237 | $237 | $237 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $155 | $155 | $155 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $268 | $268 | $268 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $93 | $93 | $93 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $189 | $189 | $189 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $266 | $266 | $266 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $174 | $174 | $174 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $189 | $189 | $189 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $231 | $231 | $231 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $247 | $247 | $247 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $155 | $155 | $155 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $201 | $201 | $201 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $93 | $93 | $93 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $182 | $182 | $182 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $274 | $274 | $274 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $89 | $89 | $89 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $157 | $157 | $157 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $527 | $527 | $527 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $445 | $445 | $445 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $334 | $334 | $334 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $397 | $397 | $397 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $157 | $157 | $157 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $361 | $361 | $361 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $1,010 | $1,010 | $1,010 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $951 | $951 | $951 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $836 | $836 | $836 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $471 | $471 | $471 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $574 | $574 | $574 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $83 | $83 | $83 |
| Spirometry CPT 94010 • Pulmonology | $8 | $8 | $8 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $9 | $9 | $9 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $28 | $28 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $13 | $13 | $13 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $63 | $63 | $63 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $19 | $19 | $19 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $22 | $22 | $22 |