| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $20 | $27 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $19 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $10 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $354 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $114 | $198 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $70 | $91 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $48 | $72 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $47 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $13 | $120 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $76 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $94 | $198 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $114 | $126 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $61 | $115 | $135 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $91 | $122 | $137 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $69 | $129 | $156 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $99 | $135 | $151 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $138 | $170 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $125 | $158 | $189 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $78 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $37 | $73 | $109 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $97 | $121 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $81 | $113 | $132 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $61 | $100 | $120 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $69 | $113 | $133 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $108 | $147 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $17 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $66 | $131 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $27 | $220 | $400 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $215 | $223 | $231 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $88 | $182 | $294 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $206 | $293 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $156 | $230 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $352 | $431 | $454 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $96 | $241 | $387 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $20 | $314 | $464 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $113 | $358 | $494 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $186 | $310 | $588 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,089 | $1,518 | $2,187 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $79 | $93 | $106 |
| Spirometry CPT 94010 • Pulmonology | $9 | $35 | $47 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $34 | $62 | $80 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $26 | $34 | $42 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $17 | $26 | $32 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $57 | $78 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $10 | $11 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $19 | $21 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $54 | $59 | $66 |