| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $26 | $26 | $27 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $25 | $27 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $40 | $40 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $34 | $34 | $35 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $21 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $14 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $14 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $316 | $316 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $257 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $89 | $92 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $65 | $94 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $35 | $37 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $170 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $73 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $133 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $107 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $112 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $113 | $115 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $116 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $92 | $114 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $130 | $140 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $159 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $91 | $93 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $63 | $104 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $101 | $102 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $113 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $115 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $123 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $15 | $87 | $131 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $27 | $33 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $119 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $208 | $235 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $90 | $143 | $195 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $152 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $119 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $137 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $273 | $273 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $13 | $80 | $131 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $189 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $255 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $312 | $956 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $91 | $91 |
| Spirometry CPT 94010 • Pulmonology | $7 | $21 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $16 | $28 | $37 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $59 | $59 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $22 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $90 | $150 |