| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $26 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $27 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $39 | $39 | $39 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $33 | $33 | $33 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $25 | $25 | $25 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $14 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $14 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $272 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $123 | $123 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $117 | $117 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $60 | $60 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $105 | $105 | $105 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $115 | $115 | $115 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $113 | $113 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $125 | $125 | $125 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $123 | $123 | $123 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $146 | $146 | $146 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $159 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $94 | $94 | $94 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $93 | $93 | $93 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $104 | $104 | $104 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $103 | $103 | $103 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $127 | $127 | $127 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $35 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $121 | $121 | $121 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $431 | $431 | $431 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $431 | $431 | $431 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $97 | $97 | $97 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $118 | $118 | $118 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $79 | $79 | $79 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $243 | $243 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $244 | $244 | $244 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $235 | $235 | $235 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $263 | $263 | $263 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $295 | $295 | $295 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $952 | $952 | $952 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $102 | $102 | $102 |
| Spirometry CPT 94010 • Pulmonology | $28 | $28 | $28 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $14 | $14 | $14 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $32 | $32 | $32 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $25 | $25 | $25 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $92 | $92 | $92 |