| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $26 | $26 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $9 | $9 | $9 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $8 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $9 | $9 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $8 | $8 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $197 | $197 | $197 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $155 | $155 | $155 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $61 | $86 | $111 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $13 | $13 | $13 |
| MMR vaccine CPT 90707 • Preventive Care | $58 | $58 | $58 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $30 | $30 | $30 |
| Varicella vaccine CPT 90716 • Preventive Care | $115 | $115 | $115 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $70 | $70 | $70 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $129 | $129 | $129 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $68 | $68 | $68 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $71 | $71 | $71 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $74 | $74 | $74 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $84 | $84 | $84 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $61 | $61 | $61 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $94 | $94 | $94 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $61 | $61 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $65 | $65 | $65 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $65 | $65 | $65 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $54 | $54 | $54 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $55 | $55 | $55 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $78 | $78 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $84 | $84 | $84 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $24 | $24 | $24 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $108 | $495 | $708 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $204 | $564 | $806 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $204 | $536 | $806 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $101 | $101 | $101 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $104 | $104 | $104 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $70 | $70 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $149 | $677 | $1,304 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $166 | $689 | $1,304 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $155 | $522 | $708 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $97 | $681 | $1,304 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $225 | $895 | $2,651 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $677 | $1,090 | $2,651 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $57 | $57 | $57 |
| Spirometry CPT 94010 • Pulmonology | $22 | $22 | $22 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $8 | $8 | $8 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $36 | $36 | $36 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $24 | $24 | $24 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $54 | $54 | $54 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $11 | $11 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $10 | $10 | $10 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $8 | $8 | $8 |