| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $14 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $3 | $9 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $10 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $291 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $97 | $102 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $87 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $31 | $47 |
| Varicella vaccine CPT 90716 • Preventive Care | $39 | $150 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $93 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $134 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $6 | $57 | $97 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $74 | $96 | $108 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $77 | $99 | $117 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $57 | $90 | $113 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $13 | $85 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $15 | $79 | $143 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $145 | $145 | $146 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $46 | $64 | $80 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $32 | $63 | $93 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $10 | $42 | $75 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $11 | $62 | $113 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $99 | $102 | $105 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $60 | $97 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $14 | $71 | $128 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $28 | $34 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $6 | $38 | $58 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $176 | $253 | $329 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $44 | $105 | $166 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $91 | $123 | $156 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $165 | $172 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $110 | $117 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $135 | $223 | $273 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $34 | $153 | $299 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $38 | $197 | $331 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $297 | $340 | $371 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $24 | $184 | $343 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $33 | $614 | $969 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $82 | $88 | $93 |
| Spirometry CPT 94010 • Pulmonology | $8 | $22 | $38 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $12 | $32 | $67 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $38 | $54 | $68 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $9 | $21 | $38 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $109 | $147 | $184 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $17 | $25 | $34 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $23 | $33 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $12 | $41 | $61 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $12 | $30 | $49 |