| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $26 | $27 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $27 | $28 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $24 | $26 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $33 | $33 | $33 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $29 | $32 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $17 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $9 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $21 | $28 | $33 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $209 | $293 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $114 | $163 | $310 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $70 | $87 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $23 | $27 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $63 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $44 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $120 | $221 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $53 | $75 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $204 | $248 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $98 | $102 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $118 | $138 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $115 | $137 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $91 | $112 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $88 | $95 | $102 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $138 | $141 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $151 | $151 | $151 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $72 | $78 | $83 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $15 | $72 | $119 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $66 | $85 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $77 | $101 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $93 | $112 | $130 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $102 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $109 | $198 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $20 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $176 | $451 | $623 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $186 | $472 | $755 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $532 | $755 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $147 | $155 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $148 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $118 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $412 | $760 | $1,121 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $319 | $736 | $1,121 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $38 | $531 | $1,121 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $124 | $670 | $1,121 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $86 | $499 | $755 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $333 | $1,041 | $2,279 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $89 | $89 |
| Spirometry CPT 94010 • Pulmonology | $7 | $15 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $35 | $44 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $39 | $39 | $39 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $22 | $26 | $30 |