| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $73 | $73 | $73 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $49 | $71 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $75 | $75 | $75 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $30 | $62 | $93 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $35 | $63 | $92 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $28 | $53 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $19 | $30 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $27 | $53 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $19 | $33 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $322 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $101 | $111 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $79 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $42 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $136 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $65 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $198 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $92 | $148 | $247 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $161 | $258 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $164 | $259 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $113 | $156 | $224 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $109 | $201 | $293 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $212 | $339 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $161 | $265 | $368 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $98 | $156 | $214 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $10 | $89 | $169 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $97 | $145 | $236 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $161 | $258 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $116 | $190 | $264 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $98 | $167 | $281 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $20 | $145 | $303 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $52 | $117 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $175 | $330 | $581 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $18 | $438 | $621 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $279 | $523 | $621 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $270 | $377 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $263 | $363 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $121 | $177 | $284 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $530 | $931 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $525 | $680 | $931 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $13 | $521 | $931 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $572 | $931 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $86 | $737 | $1,892 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $581 | $1,002 | $1,892 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $278 | $278 | $278 |
| Spirometry CPT 94010 • Pulmonology | $23 | $47 | $89 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $34 | $37 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $110 | $110 | $110 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $78 | $127 |