| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $30 | $32 | $34 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $22 | $45 | $65 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $27 | $44 | $61 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $27 | $34 | $48 |
| 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 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $6 | $7 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $11 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $11 | $17 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $41 | $155 | $268 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $275 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $18 | $82 | $116 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $27 | $41 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $82 | $105 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $67 | $93 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $115 | $205 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $133 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $181 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $11 | $60 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $109 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $13 | $95 | $161 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $10 | $114 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $10 | $115 | $180 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $15 | $114 | $177 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $16 | $122 | $227 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $34 | $85 | $136 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $60 | $97 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $88 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $17 | $88 | $159 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $9 | $67 | $109 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $115 | $119 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $159 | $186 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $8 | $8 | $8 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $184 | $184 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $169 | $211 | $252 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $36 | $136 | $235 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $131 | $147 | $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 | $13 | $74 | $180 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $26 | $28 | $30 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $172 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $99 | $215 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $17 | $70 | $123 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $152 | $766 | $1,953 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $91 | $91 |
| Spirometry CPT 94010 • Pulmonology | $12 | $20 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $10 | $22 | $37 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $12 | $37 | $59 |