| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $21 | $35 | $54 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $21 | $32 | $47 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $18 | $22 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $19 | $29 | $48 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $19 | $27 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $19 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $17 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $10 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $10 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $137 | $246 | $328 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $77 | $110 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $12 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $84 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $49 | $70 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $138 | $199 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $67 | $67 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $216 | $239 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $120 | $148 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $71 | $129 | $201 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $17 | $109 | $164 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $15 | $109 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $19 | $105 | $180 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $114 | $168 | $267 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $95 | $147 | $223 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $102 | $136 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $10 | $77 | $145 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $37 | $93 | $181 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $100 | $129 | $159 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $136 | $158 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $12 | $93 | $173 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $15 | $101 | $186 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $2 | $13 | $23 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $4 | $54 | $104 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $36 | $144 | $252 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $51 | $154 | $258 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $76 | $88 | $100 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $133 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $117 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $129 | $210 | $318 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $173 | $259 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $109 | $188 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $52 | $228 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $39 | $68 | $123 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $310 | $845 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $80 | $86 | $91 |
| Spirometry CPT 94010 • Pulmonology | $12 | $20 | $32 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $27 | $53 | $79 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $39 | $48 | $52 |