| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $17 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $15 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $14 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $9 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $272 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $236 | $246 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $85 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $15 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $69 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $30 | $47 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $132 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $66 | $112 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $115 | $205 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $107 | $139 | $162 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $11 | $94 | $156 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $36 | $104 | $163 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $12 | $95 | $184 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $7 | $94 | $178 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $13 | $102 | $160 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $14 | $103 | $172 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $89 | $112 | $135 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $33 | $90 | $143 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $31 | $67 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $71 | $101 | $157 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $35 | $77 | $119 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $14 | $93 | $171 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $76 | $139 | $184 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $33 | $53 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $10 | $125 | $239 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $60 | $228 | $446 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $178 | $313 | $448 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $76 | $132 | $220 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $153 | $226 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $121 | $154 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $312 | $369 | $477 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $62 | $251 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $120 | $256 | $326 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $14 | $290 | $443 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $87 | $278 | $468 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $36 | $805 | $1,431 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $80 | $92 | $117 |
| Spirometry CPT 94010 • Pulmonology | $9 | $29 | $47 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $16 | $37 | $54 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $13 | $47 | $76 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $22 | $38 | $51 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $34 | $128 | $207 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $18 | $24 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $22 | $30 | $42 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $31 | $49 | $70 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $37 | $50 | $57 |