| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $13 | $17 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $8 | $13 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $8 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $198 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $18 | $71 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $4 | $16 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $98 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $30 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $173 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $69 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $147 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $53 | $88 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $16 | $79 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $9 | $80 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $50 | $93 | $130 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $106 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $56 | $117 | $147 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $62 | $127 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $65 | $67 | $69 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $7 | $41 | $75 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $12 | $56 | $101 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $42 | $77 | $111 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $57 | $95 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $17 | $87 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $130 | $131 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $28 | $34 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $28 | $95 | $163 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $246 | $311 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $34 | $101 | $180 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $140 | $154 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $162 | $163 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $76 | $104 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $49 | $173 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $27 | $144 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $174 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $15 | $172 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $173 | $259 | $346 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $43 | $781 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $90 | $91 | $91 |
| Spirometry CPT 94010 • Pulmonology | $24 | $25 | $26 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $33 | $48 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $30 | $48 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $7 | $17 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $75 | $102 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $8 | $11 | $16 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $15 | $23 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $25 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $28 | $32 | $39 |