| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $15 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $1 | $12 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $10 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $34 | $216 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $229 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $86 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $16 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $80 | $95 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $29 | $39 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $148 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $108 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $161 | $245 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $63 | $103 | $142 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $71 | $105 | $149 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $57 | $102 | $155 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $80 | $108 | $134 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $49 | $107 | $170 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $57 | $120 | $197 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $62 | $133 | $214 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $43 | $87 | $128 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $9 | $77 | $136 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $63 | $89 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $10 | $84 | $150 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $88 | $112 | $153 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $36 | $102 | $163 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $51 | $105 | $175 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $31 | $44 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $105 | $146 | $187 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $60 | $129 | $205 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $91 | $138 | $206 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $76 | $113 | $164 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $141 | $218 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $102 | $147 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $113 | $192 | $318 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $148 | $215 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $153 | $250 | $326 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $175 | $334 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $29 | $156 | $396 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $24 | $406 | $947 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $80 | $89 | $106 |
| Spirometry CPT 94010 • Pulmonology | $7 | $23 | $32 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $11 | $38 | $54 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $49 | $66 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $26 | $37 | $42 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $72 | $131 | $177 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $3 | $10 | $19 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $3 | $12 | $18 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $9 | $31 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $19 | $35 | $48 |