| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $335 | $353 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $261 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $110 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $23 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $77 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $48 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $206 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $132 | $132 | $132 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $244 | $244 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $73 | $89 | $97 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $76 | $88 | $100 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $79 | $92 | $104 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $65 | $91 | $119 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $62 | $89 | $115 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $99 | $101 | $102 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $108 | $126 | $144 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $44 | $44 | $44 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $7 | $38 | $70 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $48 | $70 | $92 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $76 | $76 | $76 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $57 | $80 | $103 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $83 | $101 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $13 | $51 | $89 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $26 | $33 | $40 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $38 | $38 | $38 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $28 | $147 | $227 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $122 | $242 | $362 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $111 | $151 | $171 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $111 | $137 | $151 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $87 | $113 | $133 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $147 | $244 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $107 | $183 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $170 | $170 | $170 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $131 | $233 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $167 | $207 | $248 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $827 | $827 | $827 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $60 | $76 | $92 |
| Spirometry CPT 94010 • Pulmonology | $5 | $21 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $26 | $28 | $30 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $24 | $27 | $30 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $9 | $20 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $45 | $59 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $18 | $30 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $21 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $37 | $46 | $56 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $8 | $29 | $45 |