| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $27 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $29 | $29 | $29 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $41 | $41 | $41 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $36 | $36 | $36 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $9 | $12 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $4 | $6 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $11 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $10 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $233 | $265 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $219 | $229 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $102 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $18 | $20 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $79 | $84 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $32 | $38 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $139 | $152 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $117 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $159 | $173 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $90 | $94 | $104 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $75 | $89 | $94 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $98 | $102 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $84 | $109 | $127 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $89 | $102 | $108 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $123 | $142 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $154 | $154 | $154 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $57 | $68 | $82 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $63 | $70 | $87 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $63 | $76 | $87 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $95 | $98 | $108 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $73 | $94 | $111 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $89 | $100 | $104 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $127 | $127 | $127 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $37 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $475 | $663 | $850 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $436 | $537 | $700 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $436 | $537 | $700 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $158 | $158 | $158 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $158 | $158 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $108 | $112 | $124 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $635 | $645 | $654 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $549 | $634 | $700 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $654 | $677 | $700 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $549 | $634 | $700 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $549 | $634 | $700 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $850 | $920 | $990 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $87 | $87 | $87 |
| Spirometry CPT 94010 • Pulmonology | $26 | $26 | $26 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $36 | $36 | $36 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $59 | $59 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $14 | $14 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $146 | $146 | $146 |