| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $24 | $24 | $24 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $29 | $29 | $29 |
| 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 | $24 | $24 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $18 | $18 | $18 |
| Immunization admin injection single CPT 90471 • Preventive Care | $22 | $22 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $15 | $15 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $225 | $225 | $225 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $198 | $198 | $198 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $113 | $113 | $113 |
| 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 | $104 | $104 | $104 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $154 | $154 | $154 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $75 | $75 | $75 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $176 | $176 | $176 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $176 | $176 | $176 |
| 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 | $96 | $96 | $96 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $221 | $221 | $221 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $241 | $241 | $241 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $68 | $68 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $75 | $75 | $75 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $106 | $106 | $106 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $85 | $85 | $85 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $167 | $167 | $167 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $182 | $182 | $182 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $100 | $100 | $100 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $36 | $36 | $36 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $168 | $168 | $168 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $308 | $308 | $308 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $308 | $308 | $308 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $169 | $169 | $169 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $192 | $192 | $192 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $151 | $151 | $151 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $229 | $229 | $229 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $275 | $275 | $275 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $233 | $233 | $233 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $314 | $314 | $314 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $335 | $335 | $335 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $201 | $201 | $201 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $253 | $253 | $253 |
| Spirometry CPT 94010 • Pulmonology | $17 | $17 | $17 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $9 | $9 | $9 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $100 | $100 | $100 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $13 | $13 | $13 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $63 | $63 | $63 |