| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $26 | $32 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $25 | $46 | $79 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $22 | $44 | $76 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $22 | $28 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $48 | $48 | $48 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $41 | $41 | $41 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $26 | $40 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $23 | $31 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $19 | $34 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $16 | $31 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $318 | $368 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $289 | $468 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $106 | $114 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $33 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $73 | $108 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $64 | $96 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $200 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $131 | $233 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $209 | $241 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $106 | $175 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $204 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $118 | $192 | $270 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $105 | $170 | $232 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $102 | $168 | $282 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $139 | $248 | $345 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $279 | $326 | $373 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $100 | $137 | $158 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $131 | $226 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $104 | $148 | $172 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $97 | $180 | $248 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $99 | $185 | $255 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $115 | $205 | $287 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $46 | $173 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $59 | $63 | $67 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $285 | $350 | $415 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $21 | $248 | $455 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $140 | $389 | $793 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $184 | $263 | $352 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $248 | $361 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $181 | $244 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $22 | $318 | $606 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $329 | $504 | $680 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $604 | $616 | $628 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $825 | $847 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $482 | $877 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $549 | $1,866 | $3,182 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $223 | $223 | $223 |
| Spirometry CPT 94010 • Pulmonology | $19 | $26 | $37 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $32 | $84 | $137 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $139 | $139 | $139 |