| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $81 | $97 | $127 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $21 | $42 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $13 | $22 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $21 | $42 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $15 | $22 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $327 | $372 | $398 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $245 | $257 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $12 | $89 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $24 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $59 | $96 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $37 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $35 | $157 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $70 | $120 | $147 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $185 | $261 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $14 | $141 | $193 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $140 | $197 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $35 | $161 | $219 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $8 | $198 | $346 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $39 | $136 | $225 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $48 | $232 | $388 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $10 | $217 | $322 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $8 | $146 | $254 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $9 | $103 | $180 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $13 | $109 | $180 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $10 | $151 | $219 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $15 | $117 | $202 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $16 | $187 | $322 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $17 | $201 | $347 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $48 | $77 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $5 | $297 | $589 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $175 | $380 | $584 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $18 | $551 | $1,084 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $227 | $344 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $110 | $120 | $130 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $207 | $337 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $103 | $282 | $531 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $207 | $263 | $320 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $59 | $261 | $532 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $82 | $586 | $1,090 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $142 | $352 | $633 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $119 | $2,083 | $3,907 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $71 | $80 | $89 |
| Spirometry CPT 94010 • Pulmonology | $15 | $37 | $51 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $10 | $18 | $23 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $22 | $27 | $32 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $25 | $39 | $66 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $54 | $163 | $276 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $14 | $29 | $44 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $9 | $17 | $29 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $22 | $37 | $56 |