| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $14 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $15 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $12 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $219 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $261 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $38 | $66 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $14 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $60 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $48 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $130 | $163 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $60 | $100 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $239 | $241 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $38 | $70 | $103 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $108 | $113 | $118 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $82 | $125 | $168 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $57 | $73 | $90 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $13 | $98 | $184 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $80 | $107 | $133 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $56 | $101 | $145 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $56 | $71 | $87 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $71 | $82 | $92 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $51 | $75 | $99 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $58 | $80 | $101 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $74 | $93 | $112 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $43 | $69 | $96 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $47 | $68 | $90 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $15 | $25 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $49 | $49 | $50 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $165 | $238 | $311 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $101 | $133 | $164 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $114 | $118 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $138 | $142 | $147 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $100 | $109 | $117 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $62 | $145 | $227 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $20 | $128 | $235 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $248 | $299 | $351 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $118 | $210 | $301 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $248 | $280 | $312 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $154 | $182 | $211 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $82 | $86 | $90 |
| Spirometry CPT 94010 • Pulmonology | $8 | $11 | $13 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $11 | $25 | $38 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $40 | $43 | $45 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $27 | $40 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $26 | $51 | $77 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $15 | $24 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $18 | $20 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $11 | $37 | $63 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $24 | $25 | $25 |