| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $76 | $127 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $31 | $63 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $15 | $29 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $30 | $56 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $19 | $40 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $315 | $398 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $258 | $312 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $86 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $17 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $99 | $105 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $36 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $204 | $232 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $81 | $142 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $190 | $261 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $16 | $148 | $283 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $11 | $154 | $295 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $7 | $158 | $307 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $8 | $195 | $346 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $15 | $146 | $247 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $114 | $197 | $299 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $10 | $184 | $322 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $60 | $135 | $176 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $9 | $154 | $272 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $14 | $139 | $271 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $7 | $143 | $296 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $7 | $171 | $303 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $94 | $182 | $322 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $8 | $196 | $347 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $2 | $42 | $77 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $16 | $302 | $589 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $12 | $385 | $1,083 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $61 | $572 | $1,084 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $76 | $203 | $432 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $212 | $431 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $169 | $337 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $239 | $466 | $775 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $52 | $270 | $412 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $76 | $469 | $798 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $35 | $513 | $1,090 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $42 | $317 | $633 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $142 | $1,805 | $3,907 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $80 | $139 | $258 |
| Spirometry CPT 94010 • Pulmonology | $32 | $46 | $60 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $11 | $29 | $54 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $53 | $78 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $17 | $58 | $106 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $85 | $193 | $425 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $3 | $25 | $42 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $15 | $33 | $46 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $57 | $149 |