| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $12 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $8 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $137 | $233 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $46 | $80 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $19 | $69 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $31 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $129 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $128 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $122 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $16 | $68 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $11 | $82 | $124 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $83 | $109 | $129 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $122 | $146 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $48 | $105 | $142 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $12 | $107 | $164 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $62 | $133 | $178 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $99 | $106 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $108 | $113 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $78 | $83 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $112 | $118 | $124 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $57 | $90 | $127 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $14 | $81 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $123 | $146 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $28 | $41 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $8 | $112 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $68 | $151 | $234 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $169 | $254 | $413 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $131 | $144 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $170 | $184 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $124 | $126 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $160 | $215 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $13 | $149 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $252 | $293 | $335 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $245 | $356 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $173 | $285 | $398 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $258 | $832 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $94 | $101 |
| Spirometry CPT 94010 • Pulmonology | $18 | $24 | $29 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $14 | $23 | $37 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $32 | $51 | $63 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $16 | $25 | $37 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $75 | $108 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $11 | $19 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $8 | $13 | $18 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $14 | $31 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $12 | $33 | $44 |