| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $25 | $36 | $43 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $42 | $61 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $17 | $37 | $53 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $23 | $30 | $38 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $15 | $19 |
| Immunization admin injection single CPT 90471 • Preventive Care | $6 | $17 | $25 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $11 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $336 | $365 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $280 | $338 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $67 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $4 | $19 | $29 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $66 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $50 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $39 | $135 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $150 | $175 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $153 | $282 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $53 | $53 | $53 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $8 | $98 | $154 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $41 | $115 | $166 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $6 | $104 | $163 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $9 | $116 | $177 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $13 | $116 | $177 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $16 | $135 | $208 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $11 | $144 | $225 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $7 | $81 | $118 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $35 | $85 | $131 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $35 | $85 | $129 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $8 | $85 | $144 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $39 | $109 | $146 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $43 | $118 | $161 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $48 | $115 | $177 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $29 | $42 | $55 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $10 | $87 | $164 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $18 | $364 | $710 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $30 | $370 | $710 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $127 | $144 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $138 | $202 | $267 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $91 | $135 | $179 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $124 | $314 | $447 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $265 | $366 | $495 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $93 | $220 | $324 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $109 | $368 | $629 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $316 | $349 | $414 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $114 | $1,267 | $2,255 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $76 | $106 | $126 |
| Spirometry CPT 94010 • Pulmonology | $13 | $34 | $57 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $9 | $51 | $96 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $9 | $104 | $226 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $6 | $23 | $45 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $58 | $135 | $191 |