| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $31 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $35 | $38 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $28 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $10 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $336 | $344 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $249 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $102 | $110 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $78 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $53 | $70 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $187 | $199 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $65 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $163 | $221 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $96 | $109 | $125 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $100 | $120 | $155 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $105 | $136 | $210 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $70 | $130 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $98 | $130 | $177 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $82 | $146 | $209 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $123 | $164 | $227 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $87 | $105 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $51 | $88 | $145 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $91 | $110 | $144 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $60 | $109 | $156 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $104 | $124 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $67 | $105 | $135 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $89 | $186 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $21 | $27 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $44 | $94 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $199 | $317 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $117 | $171 | $258 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $95 | $119 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $138 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $116 | $131 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $194 | $318 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $263 | $304 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $66 | $110 | $152 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $194 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $123 | $283 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $152 | $892 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $70 | $75 | $80 |
| Spirometry CPT 94010 • Pulmonology | $15 | $26 | $32 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $28 | $43 | $59 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $35 | $42 | $52 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $11 | $27 | $52 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $109 | $210 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $8 | $15 | $23 |