| Immunization admin first vaccine component CPT 90460 • Preventive Care | $13 | $19 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $8 | $13 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $4 | $8 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $248 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $77 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $12 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $100 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $28 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $145 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $65 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $161 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $8 | $71 | $135 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $8 | $76 | $144 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $41 | $127 | $213 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $89 | $135 | $180 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $45 | $139 | $234 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $10 | $110 | $210 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $13 | $153 | $294 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $7 | $65 | $124 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $89 | $188 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $25 | $94 | $187 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $39 | $83 | $152 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $58 | $116 | $211 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $155 | $224 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $48 | $114 | $180 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $14 | $37 | $60 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $5 | $86 | $203 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $49 | $298 | $669 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $104 | $655 | $1,206 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $170 | $291 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $191 | $299 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $90 | $128 | $203 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $40 | $460 | $880 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $19 | $499 | $980 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $93 | $288 | $482 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $22 | $291 | $560 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $80 | $576 | $1,331 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $571 | $2,318 | $4,064 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $76 | $114 | $190 |
| Spirometry CPT 94010 • Pulmonology | $5 | $11 | $17 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $23 | $75 | $127 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $9 | $38 | $66 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $12 | $27 | $52 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $64 | $128 | $193 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $28 | $40 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $11 | $24 | $36 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $50 | $89 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $10 | $24 | $35 |