| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $24 | $28 | $32 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $26 | $28 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $11 | $19 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $18 | $23 | $28 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $29 | $37 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $24 | $29 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $16 | $22 | $26 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $17 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $19 | $26 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $16 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $225 | $289 | $369 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $254 | $304 | $386 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $110 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $26 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $106 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $55 | $57 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $134 | $171 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $131 | $158 | $201 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $154 | $194 | $241 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $96 | $141 | $172 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $105 | $149 | $180 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $123 | $162 | $187 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $189 | $197 | $210 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $138 | $177 | $204 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $215 | $224 | $237 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $144 | $194 | $256 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $140 | $146 | $155 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $109 | $143 | $165 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $84 | $133 | $165 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $95 | $146 | $181 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $94 | $135 | $184 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $178 | $186 | $196 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $115 | $172 | $211 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $43 | $51 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $121 | $143 | $165 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $301 | $424 | $541 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $302 | $425 | $541 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $166 | $261 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $148 | $216 | $261 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $105 | $142 | $205 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $188 | $204 | $221 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $189 | $206 | $222 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $191 | $202 | $214 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $353 | $428 | $504 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $251 | $260 | $268 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,001 | $1,384 | $1,767 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $82 | $107 | $131 |
| Spirometry CPT 94010 • Pulmonology | $17 | $34 | $45 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $64 | $75 | $91 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $31 | $59 | $87 |