| Immunization admin first vaccine component CPT 90460 • Preventive Care | $9 | $14 | $17 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $8 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $8 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $8 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $140 | $214 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $168 | $210 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $66 | $92 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $4 | $13 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $58 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $25 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $139 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $71 | $76 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $94 | $140 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $73 | $79 | $82 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $55 | $67 | $86 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $9 | $52 | $89 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $76 | $81 | $91 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $37 | $74 | $97 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $13 | $47 | $80 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $12 | $82 | $122 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $65 | $66 | $66 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $8 | $39 | $71 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $9 | $40 | $70 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $7 | $42 | $77 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $7 | $43 | $79 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $47 | $84 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $50 | $71 | $91 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $19 | $27 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $53 | $74 | $117 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $125 | $160 | $178 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $178 | $200 | $221 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $145 | $162 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $112 | $141 | $161 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $76 | $104 | $118 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $23 | $137 | $228 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $90 | $146 | $256 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $13 | $90 | $168 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $22 | $194 | $329 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $33 | $209 | $350 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $42 | $641 | $1,149 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $62 | $78 | $86 |
| Spirometry CPT 94010 • Pulmonology | $19 | $23 | $26 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $8 | $30 | $41 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $11 | $29 | $57 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $22 | $24 | $26 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $47 | $90 | $143 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $2 | $7 | $12 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $11 | $13 | $15 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $25 | $36 | $49 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $8 | $26 | $40 |