| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $26 | $30 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $38 | $43 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $35 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $17 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $274 | $279 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $219 | $245 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $89 | $92 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $19 | $71 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $38 | $42 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $134 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $56 | $100 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $146 | $225 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $92 | $100 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $101 | $107 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $71 | $102 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $115 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $86 | $114 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $133 | $144 | $152 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $113 | $144 | $161 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $62 | $81 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $93 | $104 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $88 | $94 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $98 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $78 | $93 | $109 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $107 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $116 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $14 | $28 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $153 | $168 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $36 | $187 | $289 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $164 | $200 | $235 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $143 | $156 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $151 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $100 | $119 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $59 | $116 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $132 | $235 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $131 | $175 | $220 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $120 | $301 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $26 | $161 | $319 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $959 | $1,172 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $81 | $86 | $91 |
| Spirometry CPT 94010 • Pulmonology | $7 | $25 | $31 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $39 | $51 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $25 | $42 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $13 | $21 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $80 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $19 | $30 |